MINISTRY OF PUBLIC HEALTH OF UKRAINE



MINISTRY OF PUBLIC HEALTH OF UKRAINE

Vinnitsya National Medical Pirogov Memorial University.

Department of infectious diseases

Ratified

on a methodical conference

“____” _____________ 200

Chief of department, professor Moroz L.V.

M E T H O D I C A L M A T E R I A L S

for organization of self-contained work of V course medical faculty students

(on the topic included in the education plan).

Topic: THE SODOKU

Made by assistant Belyakova T.A.

2009

1. Actuality of theme

Sodoku (ratbite disease) is infectious pathology widespread on all continents but Antarctica. In spreading of the disease rats which are basic vessel and infection source play leading role. The feature of rats as infection source is the following: they live everywhere, migrate not only in measures of certain settlement but far distances quite easy. Using cargo vehicles the rats are able to overcome thousands kilometers, water obstacles and even achieve other continents. Apart from that the incitant of sodoku doesn’t affect the viability of rats, because it is their saprophyte and increase in infected rats population increases the risk of human infection. The highest level of rats infection contamination by sodoku germ is observed in countries of East and South-East Asia. As for humans sodoku disease is registered mainly as sporadic cases, more often in Asian countries also. In European countries, in Ukraine in particular, sporadic cases of disease are registered. However, there are reasons to believe that in Ukraine there are considerably more cases of sodoku disease then it is registered. First, the reason is lack of awareness as for the disease, absence of epidemiological alertness and appropriate diagnostic system. Especially it should be emphasized that there is possibility of bad and very bad course of sodoku disease, and the absence of adequate etiotropic treatment can lead to death.

2. Seminar educational aims (with pointing of planned mastering level):

.

2.1. A student must learn: a-1

Spread of sodoku on the earth.

2.2. A student must know: a-2

- etiology of sodoku and factors of pathogentsis of Spirillae minus;

- epidemiology of sodoku;

- clinical classification of sodoku;

- pathogenetic features of infection;

- clinical signs of sodocu in typical and chronic treatment;

- clinical signs of possible complications and possible consequences of disease;

- methods of specific diagnostics of sodoku;

- criteria of diagnostics of sodoku;

- clinical pictures of diseases that differs from sodoku;

- principles of treatment;

- discharge rules of convalescents and prophylaxis of sodoku

2.3. A student must be able: (a-3)

- to collect complaints, anamnesis of illness and epidimiological anamnesis of patient;

- to inspect the patient and find out basic symptoms of sodoku;

- to formulate and justify a preliminary diagnosis;

- to issue a hospital record and message to SES;

- to work out on the plan of laboratory and instrumental inspection of patient considering the stage of disease;

- to work out on the plan of treatment considering the stage and severity of illness, presence of complications, allergy anamnesis and сопутствующая pathology;

- to interpret the results of clinical methods of inspection;

- to analyze the results of specific diagnostic methods;

- to conduct differential diagnostics of sodoku;

- to give recommendations in relation to the mode, diet and supervision in the period of rehabilitation.

2.4. Creative level (for the most capable students):

To develop creative abilities of students in the process of clinical investigations, scientific sources analysis; to engage students in work in the student scientific group of department; to offer themes for learning and science investigation on the most actual question.

2.5. Educational aims (aims of personality development):

• To develop deontological presentations in the process of theme study. Ability to adhere the rules of conduct bedside of patient, principles of medical deontology. To seize abilities to set a psychological contact with a patient and his family.

• To develop imagination of social factors influence the sodoku spread.

• To develop feeling of responsibility for a timeliness and professional level of doctors actions.

3.1. Basic knowledge, abilities skills needed for topic inquiry (intersubject integration)

|Discipline |To know |To able |

|Microbiology |Structure and properties of Spirillae minus, its |To interpret results of microscopic and bacteriologic |

| |constancy in environment, irritability to antibiotics |tests. |

| |and dezinfectors. | |

|Physiology |Parameters of physiological norm of human systems and |To find out aberrations of laboratory indicators and |

| |organs functioning according to indicators of |instrumental researches results. |

| |laboratory (blood test, urinanalysis, biochemical | |

| |blood, coagulogram, ionogram and results of | |

| |instrumental (ECG, Rn, ultrasonography) and other | |

| |researches. | |

|Pathophysiology |Mechanism of organs and systems malfunctions in |By results of laboratory and instrumental investigations to|

| |pathological conditions of different genesis. |determine functional disorders and organic changes of |

| | |organs and systems. |

|Immunology and allergology |Bases of cell-mediated and humoral immunity. |To evaluate the results of immunological investigations. |

| |Immunological aspects of infection process. | |

| |Elimination time of disease agent from organism, | |

| |development of immunity. | |

|Epidemiology |Elements of epidemiological process. Source, |To collect epidemiological anamnesis. |

| |mechanisms of infection by sodoku. Risk groups and | |

| |features of disease spreading in different world | |

| |regions. | |

|Dermatology |Characteristic of rash elements. Features of rash of |To evaluate the character of rash, its overwhelming |

| |different genesis. |localization, time of appearance from disease beginning. |

|Propedeutics of internal |Basic phases and methods of patient clinical |To collect complaints, anamnesis, epidemiological |

|illneses |inspection. |anamnesis, conduct the clinical inspection of patient. To |

| | |find out basic symptoms of sodoku. To formulate and |

| | |justify diagnosis. |

|Clinical pharmacology |Pharmacokinetics, pharmacodynamics, possible adverse |To appoint ethiotropic and nosotropic treatment depending |

| |reactions and contraindications to the use of |on age, individual features of patient, to choose the |

| |penicillin, tetracycline and nosotropic therapies. |optimum mode of reception and dose of preparation, write |

| | |recipes. |

3.2 Structural-logistic scheme of the seminar topic.

|Ratbite disease. Sodoku |

4. Approximate content of the topic

|Section |Content of the theme |

|Etiology |Activator |Spirillum minus (Spirochaetа minus) |

| |Structure |Штопороподобные, sulkated bacteria with 2-3 pinstripes, size is 2-5 х 0,5 mkm, there is one or more flagellum.|

| |Properties |Грамнегативные, don’t form spores and capsules, are not inclined to L-transformation. Mobile – there are 3-9 |

| | |filaments on both poles. Antigenic structure is not researched, endotoxin is formed at the death. Propagated by|

| | |simple division, grow slowly in artificial media. |

| | |Unstable in the surrounding, die under the influence of different disinfectants and during boiling. Sensitive |

| | |to the tetracycline and penicillin. |

| |Source | Basic activator vessel and source of infection is rat, less – dogs, cats, squirrels, ferrets and other |

| | |rodents. Illness patient is not dangerous for surrounding. |

| |Route of infection |Circulation of activator among the animals is by the bite. The posterity is infected in transplacentary way and|

| | |through milk. |

| | |Spirilla comes to the human organism by the bite of an infected animals or saliva the damaged skin. |

| |Spreading and risk |Human susceptibility to spirilla is high. However the disease is registered as sporadic cases, more often they |

| |groups |are persons which have direct contact with rodents (dezinfectors, deratizators, busters, plumbers). The disease|

| | |makes immunity. |

|Classification |By duration |Acute and protracted (some monthes) illness |

| |By severity |Mild, medium and nasty illness. |

| |Other |Ilness is possible in abort form. |

|Pathogenesis |Links |Spirilla gets to the wound by bite or saliva ( reproduction in the place of penetration ( lymphogenic |

| | |dissemination through the whole body ( formation of the secondary activator breeding centers in organs and |

| | |systems ( bacillemia ( hematogenic dissemination with formation new secondary activator breeding centers ( |

| | |activization of nonspecific and specific immune defense factors, elimination of activators from organism. |

| | |The reason of sodoku backsets is multiple bacillemia. |

| |Organs and systems |Structural and functional derangements in different organs and systems are predetermined by direct activity by |

| |damage |spirilla which can not only penetrate in organs, but also breed there with formation of the secondary centers. |

| | |One more damaging factor is allergic reaction, growing anemia and as a result – hypoxia. |

|Clinics |Incubation period |Fluctuates from 3 days to 2 months, in average is 10-14 days. During incubation period the wound made by animal|

| | |heals completely. |

| |Beginning of the illness|The illness begins acutely with temperature rose to до 39-40°С. More often the temperature is intermittent, |

| |(the 1st stage) |with chill, headache, mialgia and arthralgia, sometimes neuralgia, paresthesia is possible. |

| | |At the same time in the beginning of illness in the bite place tight algetic infiltrate, surrounding by |

| | |hyperemia, forms. During several days a deep ulcer with underlined edge forms (primary affect). Regional |

| | |lymphadenitis and lymphangitis are developed. In several days the ulcer heals and usually doesn’t leave trace.|

| | | |

| | |Duration of the first febrile attack is 4-7 days. On the 5-7th day the temperature falls that accompanied by |

| | |pouring sweat and collaps is possible. |

| |Remission |Lasts 3-7 days. Being satisfactory, but there is severe weakness. Sometimes low-grade fever is saved. |

| |Backset |The next attack of disease begins and goes on as the previous one. High temperature, intense myalgia, floating |

| | |arthralgia, sometimes conjunctivitis appears. Unlike beginning of disease, there is no primary affect in the |

| | |backset, but the rash appears in the chill. The rash is polymorphous, more often papules and dots to 0,5 cm in |

| | |diameter not inclined to merge. Vesicles, petechiae, subcutaneous nodules can appear. Rash elements appear |

| | |firstly in the place of bite and then very quickly spread on the whole body including palms and soles. Rash can|

| | |cover only one part of body (hand, leg, body) in a form of sleeve, jacket, half of paints. Rash is saved 3-5 |

| | |days and disappears with the temperature reduction and there is no pigmentation. The temperature falls |

| | |critically with pouring sweat. |

| |Next backsets |In the whole there are from 5 to 20 febrile attacks, dividing by periods of apyrexia. With each new attack the |

| | |fever duration and its height decrease and duration of apyrexia period increases (sometimes to sezeral weeks |

| | |and even months). Each backset ends with critical temperature reduction. |

| | |In apyrexia periods patients feel satisfactory, there is only sever weakness. Convalescence without treatment |

| | |is possible. |

| |Severity of disease |Pronounced intoxication syndrome, temperature rises to 40-41°С, unbearable headache, myalgia, arthralgia. |

| | |Sometimes severe damage to the nervous system is possible (even paralysis). Also visual and hearing |

| | |impairment, visceral injury (heart, lungs, nephros, hepar). |

| |Mean disease severity |Intoxication syndrome and fever are less pronounced. Visceral are mainly functional. |

| |Mildly disease |Intoxication is not considerable, temperature is 38-38,5°С, regional lymphadenitis and lymphangitis weakly |

| | |expressed, inconsiderable organs and systems dysfunctions. |

| |Prolonged duration of |Attacks of illness are registered during a lot of months and even a year. Numerous backsets weaken the |

| |disease |patients. They accompanied by progressive loss of weight up to cachexia, that can be a reason of death. In |

| | |result of depletion of the protective forces other infections can add. It can also lead to the death. |

| |Abortive course of the |Illness ends by convalescence after the first fever attack before the rash appearance. |

| |disease | |

|Complication | CNS |In the early stages there is mainly headache, later - paresthesia, less paresis and paralysis, mental |

| | |aberrations are possible. |

| |Heart |Myocarditis, endocarditis, pericarditis. |

| |Lungs |Spirillous bronchopneumania. In the prolonged duration of disease the secondary bacterial flora can be a reason|

| | |of pneumonia. |

| |Nephros |Nearly 10% patients have nephrite. Oedemata can appear, that is caused by nephritic pathology and protein loss.|

| |Other organs |In the prolonged duration of disease splenomegaly and enlargement of the liver with dysfunction is possible. |

|Prognosis | |Even without treatment a patient can recover after 5-8 attacks (nearly in 1-2 months). Forms with severity of |

| | |disease can lead to death in 6-10% cases. In cases when treatment is absent or treatment was begun late the |

| | |possibility of complications and adverse effects considerably increases. |

|Laboratory diagnostics |General clinical methods|In the beginning period – neutrocytosis (to 30х109/l), aenosinophilia. At the height of the disease and in |

| | |backsets – lymphocytosis, eosinophilia, anaemia. During the whole period – growth of ESR. |

| | |Because of fever there is protein and single erythrocytes in urine. |

| | |If there are complications it is necessary to make ECG, USI, cardiotocography, roentgenography and others. |

| |Specific methods |Microscopy. Spirilla can be found out in phase-contrast microscopy in blood, biopsy slice of lymph glands, |

| | |discharge from the wound. It is possible to research thick drop of blood, stained by Romanovsky-Gimza method. |

| | |Bioassay test. The test is carried out on white mice. 2-3 ml of blood or other research material are entered |

| | |ip. In 5-10 days abdomen exudate and inguinal lymph nodes are researched. These methods are used seldom. |

| | |Serologic methods. More often the reaction of spirilla lysis and reaction of agglutination are used. The |

| | |reaction of complement deflection and reaction of immunofluorescense, which become positive at the 8-10th day |

| | |are used less. |

|Criteria of diagnosis |Epidemiological features|Rat bite in terms till 2 months before disease beginning; |

| | |Bite of squirrel, cat in the same terms; |

| |Clinical features |Typical primary affect with regional lymphadenitis and lymphangitis; |

| | |Sudden acute beginning with high temperature and pronounced intoxication syndrome; |

| | |Polymorphous rash because of temperature. The rash spreads from the bite place; |

| | |backsets; |

| | |in separate cases prolonged duration of the disease (several months and even a year); |

| |Laboratory features |leucocytosis, aenosinophilia, during illness - eosinophilia |

|Differential |Epidemic roseola differs|Absence of primary affect, regional lymphadenitis and repeated paroxysms of fever; presence of pronounced |

|diagnostics | |catarrhal syndrome from the first day of illness, typical rash, stages of rash, short duration. |

| |Rubella differs |Absence of primary affect, increasing of occipitalis lymph nodes only, mildly ill without high temperature and |

| | |pronounced intoxication, presence of catarrhal syndrome from the first day, short duration. |

| |Typhus differs |Transmissive transfer mechanism, absence of primary affect, regional lymphadenitis, fever of constant type |

| | |during for 2 weeks, without backsets, with typical rash placed mainly on flexor surface , positive symptom of |

| | |Govorov – Godelye, increased fragility of vessels, that is expressed by corresponding positive symptoms of: |

| | |Kiari – Avtsin, Ditch, Rumpel-Konchalovsky, Urgens. |

| |Tick fever differs |Connection between illness and tick bite, short duration of fever paroxysms, character of primary affect |

| | |(duration for about 3-4 weeks, papule without wound formation is saved), absence of regional lymphadenitis, |

| | |lymphangitis and rash. |

| |Malaria differs |The illness is connected with mosquito bite, there are clear intervals between fever paroxysms (48 or 72 |

| | |hours), Banti syndrome, absence of primary affect, lymphadenitis and rash. |

| |Skin form of Siberian |Dynamics of local changes: macula ( papule ( vesicle ( plague with a black crust on the bottom and whisk |

| |plague differs |subsidiaries pustules on the edge surrounded by inflammatory roller with massive edema, absence of pain |

| | |irritability, repeated fever attacks and rash. |

| |Bubonic plague |Prolonged fever (till 3 weeks) without repeated paroxysms, absence of rash, features of primary affect and |

| | |lymphadenitis (regional lymph nodes are enlarged considerably, painful and prone to fester and/or |

| | |sclerotherapy. |

| |Lyme disease differs |The disease is connected with tick bite, gradual development of the disease. Swelling and itching in the place|

| | |of mite sucking, more often subfebrile fever, the typical feature is erythema migrans. |

| |Secondary syphilis |Epidemiologic data, local reaction in the form of chancre on external genital organs, as a rule, rash with its|

| |differs |long-term reservation, satisfactory condition of the patient. |

| |Others |Besides, sodoku is differentiated with pediculous typhus, sepsis, vesicular rickettsiosis, Marseilles fever, |

| | |benign inoculation reticulosis, brucellosis, reumathic disease and other infectious and non-infectious |

| | |diseases. |

|Treatment |Ethiotropic |The most effective is penicillin (1 mln. 6 times a day intramusculary). Treatment course is not less then 7 |

| | |days, but it is better to prolong it to 14 days. If there are complications a day dose increases, in |

| | |particular, in endocarditis the dose is 16-20 mln. If there is intolerance to penicillin tetracycline is |

| | |assigned, a day dose is to 2 g in 4 times in oral way. There is information about effectiveness of erythromycin|

| | |and laevomycetin. |

| |Patogenetic |The character of patogenetic therapy is defined by features of disease and depends on depth and volume of |

| | |organs and systems damaging. |

|Prophylaxis |General |Measures against rodents, including deratizaion. Health education especially of the persons from risk groups. |

| |Specific |Is not worked out. |

| |Emergency |Tetracycline is assigned to the person bitten by rat. A day dose is to 2 g in oral way during 3 days. |

5. Plan and organizational of seminar structure:

|Basic stages of employment, their |Educational aims are in |Control methods and studies|Materials of the methodical |Time |

|functions and maintenance. |the levels of mastering | |providing : control, instruction |(min) |

|1 |2 |3 |4 |5 |

|1. Preparatory stage: | |Interview. Individual |. See 1.1 ”Actuality of theme”; | |

|Seminar organization | |questioning. Test control. |See 1.2 the ”Educational aims” |15 min. |

|Raising of educational aims and | | | | |

|motivation | | |Questions for the individual | |

|Control of knowledge initial level | | |questioning. | |

| |II | | | |

|A table of contents is See of 1.2.1; | | |Tests of 2nd level | |

|1.2.2 the ”Educational aims” | | | | |

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|2. Basic stage | |Practical training at the |Taking care of thematic patients. | |

|Forming the system of professional |III |decision of various |Hospital charts. Extracts from |60 min. |

|abilities and skills. | |(typical and off type) |hospital charts. | |

|A table of contents see 2.2; 2.3 the| |clinical tasks. |Archived hospital charts | |

|”Educational aims” | | |Situational tasks of 2,3th level. | |

|3. Final stage | |Individual control of |Tests of 3rd level | |

|Control and correction of |III |practical skills and |Situational tasks of 3rd level. |15 |

|professional skills and abilities | |professional actions of | | |

|level | |students. Analysis of | | |

|Assume of the seminar | |typical errors. | | |

|Home task with the list of thematic | |Test control. | | |

|educational literature (basic, | | | | |

|additional) | | | | |

7. Methodical materials .

7.1.1. Self-control questions

1. Structure and properties of sodoku activator?

2. Constancy of Spirillum minus in the environment and irritability to dezinfector.

3. Sources and route of infection.

4. Группы черточки относительно заражения возбудителями содоку.

5. Pathogenetic elements of infection disease.

6. Clinical symptoms of sodoku.

7. Skin manifestations in the first disease attack and backsets of sodoku.

8. Complications of sodoku.

9. Changes in blood test and urinanalysis.

10. Methods of specific diagnostics of sodoku.

11. Criteria of diagnostics of sodoku.

12. Ethiotropic therapy of sodoku: preparations, doses.

13. Principles of pathogenetic and symptomatic therapy of sodoku.

7.2. Tests of the 2nd level.

Variant 1.

1. 145. Infectious invader of Haverhill fever:

А. бета-гемолитический streptococcus GABH

B. Spirillium minus

C. Streptobacillus moniformis

1. 146. Transmission mechanism of Haverhill fever:

А. airborne

B. traumatic (after rat bite)

C. parenternal

D. alimentary

1. 147. Patients with sodoku are dangerous for surrounding in epidemic relation:

А. yes

B. no

C. sometimes, in severity of disease

1. 148. Primary affect in Haverhill fever:

А. unstable, it is absent more often

B. natural sign

17.1.149. It is typical for sodoku:

А. arthritis (joint disease).

B. mainly neuralgia

C. joint are not damaged

1. 150. Rash in Haverhill fever:

А. appears with the second ague

B. usually appears from the first days of disease

C. is absent

Variant 2.

2. 151. Call the activator of sodoku:

A. Yersinia pestis

B. Bacillus antrax

C. Spirillium minus

1. 152. Transmission mechanism of sodoku:

А. traumatic (after rat bite)

B. alimentary

C. airborne

17.2.153. Are patients with Haverhill fever dangerous for surrounding:

А. yes

B. sometimes, in severity of disease

C. no

17.2.154.Regional lymphadenitis and lymphangitis in sodoku:

А. is absent

B. permanent feature

C. sometimes

17.2.155. What clinic symptom is one of the most constant in sodoku:

А. apnea

B. chill

C. diarrhea

17.2.156. Rash in Haverhill fever:

А. polymorphous, plethorical, has a tendency to merge, with itch

B. identity elements in the form of roseola on the anterior abdominal wall

C. punctuate rash on limbs around the joints

Variant 3.

17.3.157. Activators of sodoku and Haverhill fever:

А. viruses

B. bacteria

C. archaeal

17.3.158. In what disease epidemic outbreaks are possible:

А. sodoku

B. Haverhill fever

17.3.159. The primary affect in sodoku:

A. is absent

B. natural sign

17.3.160 Regional lymphadenitis and lymphangitis in :

А. constant feature

B. sometimes if the primary affect is present

17.3.161. Rash on the body in sodoku:

А. usually appears from the first days of disease

B. not typical

C . appears with the second ague

17.3.162. In Haverhill fever:

А. often arthralgia appears

B. arthritis of knee and elbow joints with exudate

C. joint disease is not typical

Faithful answers

|Variant 1 |Variant 2 |Variant 3 |

|17.1.145. C |17.2.151. C |17.3.157.B |

|17.1.146. B,C |17.2.152. А |17.3.158. B |

|17.1.147. B |17.2.153. B |17.3.159. B |

|17.1.148. А |17.2.154. B |17.3.160. B |

|17.1.149. B |17.2.155. B |17.3.161. C |

|17.1.150. B |17.2.156. А |17.3.162. B |

7.3. Situational tasks (the second mastering level) a-2.

Task 1.

Patient P, 32 years, complains about temperature rise to high numbers, headache, myalgia and arthralgia. Patient has been ill for 3 days. Illness was begun acutely in 2 weeks after the rat bite. Objectively: there is a deep ulcer with underlined edge in the area of wrist joint on the right hand, axillary lymph nodes are felt. The patient says that ulcer formed at the site of wound which had healed after rat bite.

1. Formulate a preliminary diagnosis.

2. Inspection plan

3. Treatment.

Task 2.

Patient G., 49 years, is disinfector-deratizator, has been ill for 2 weeks. Illness was begun acutely from temperature rise to high numbers, headache, myalgia and arthralgia. On the 7th day the temperature dropped and during 5 days it was kept in measures of physiological norm.на фоне выраженной слабости. Then the symptomatic of disease resumed again. Objectively: increase in irritation and maculo-papular rash on the skin of the left leg, femora and posterior.

1. Formulate a preliminary diagnosis.

2. Inspection plan

3. Treatment.

Task 3.

Patient G., 25 years, deliverd to the doctor at the 5th week of illness, earlier treated herself. Complaints of periodic febrile attacks, chill, headache, myalgia and arthralgia during 1 week. These symptoms are alternated with such periods of apyrexia. During the 3d attack the heartache, despnea and heartbeat appeared. It was found out from anamnesis that the patient was ill in about 10 days after rat bite. Objectively: polymorphous, mainly maculo-papular rash on the skin of the right upper limb, rhythm of gallop is listened, на ЭКГ наблюдаются блокада ножек пучка Гиса и желудочковые экстрасистолы.

1. Formulate a preliminary diagnosis.

2. Inspection plan

3. Treatment.

Task 4.

Patient L., 42 years, delivered to the hospital infection with diagnosis “Fever of unclear etiology”. The patient has been ill for 3 months. It is found out from anamnesis that he had been bitten by squirrel 2 weeks before disease beginning. The disease is in a form of periodic attacks with fever, headache, myalgia, arthralgia, polymorphous mainly macula-papular rash on the skin of body. Disease attacks go on during a week and alternate with the same periods of apyrexia, From the beginning of illness the patient lost 22 kg. It was found signs of bronchopneumonia.

1. Formulate a preliminary diagnosis.

2. Inspection plan

3. Treatment.

Tests of the 3d level.

To complete a table (a-3)

Dynamics of sodoku clinical symptoms

| |The first attack of |Remission |Backset |

|Term illness |illness | | |

| | | | |

|Symptoms | | | |

|Temperature rises to high numbers |+ |- |+ |

|Normal body temperature, low-grade fever |- |+ |- |

|Shivers |+ |- |+ |

|Headache |+ |- |+ |

|Backache |- |- |- |

|Myalgia and arthralgia |+ |- |+ |

|Marked weakness |- |+ |- |

|Paresthesia |+ |- |+ |

|Paresis, paralysis |- |- |+ |

|Primary affect |+ |- |- |

|Regional lymphadenitis and lymphangitis |+ |- |- |

|Rash |- |- |+ |

|Conjunctivitis |- |- |+ |

Рекомендуемая литература:

Основная:

1. Возианова Ж.И. Инфекционные и паразитарные болезни: в 3 т. – К.: Здоровье, 2001 – Т 2. – С. 638-655.

2. Лобзин Ю.В. Руководство по инфекционным болезням. С-пб. „Фолиант”, 2000. – С. 233-235.

3. Инфекционные болезни: Учебник / Под ред. Е.П. Шуваловой – 5-ое издательство – М: Медицина, 1995. – С. 647-650.

Дополнительная:

1. Инфекционные болезни. Учебник / Под ред. М.Б. Титова. – К.: Высшая школа, 1995. – С. 524-526.

2. Покровский В.И., Поздеев О.К. Медицинская микробиология. Г. „ГЕОТАР Медицина”, 1998. – С. 497-498.

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Prevention

Deratization actions

Emergency prevention

Ethiotropic

Treatment

Pathogenetic

Symptomatic

Diagnostics

Microscopy

Bioassay test

Serologic

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Cachexia

Miocarditis, endocarditis

Bronchial pneumonia

Paresis, paralysis

Chill, intoxication

Regional lymphadenitis

Marginal temperature decreasing, weakness, profuse hidrosis

Іncubation period

Reduction in the duration of backsets with increasing of their number

Symptoms of damage of internals and CNS

1st attack of disease

Remission

Backsets

Clinic

anaplerosis

Hyperemia, induration

vesicle

Chancre

Epulosis

Polymorphous eraptions spreading from morsus place

Pathogenesis

Elimination of activator

Immunity

Reproduction

lymphogenic dissemination

Penetration

Formation of secjydary centers

bacteriemia

hematogenic dissemination

Specific factors of protection

Rats, rarely other rodents, dogs, cats

Bite or ослинение of damaged skin

Persons contacting with rodents

Epidemiology

Source

Route of infection

Risk groups

Etiology

Spirillium minus (Spirochaetа minus). Morphology, constancy in environment, irritability to antibiotics and dezinficants.

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