Care of patients with infectious diseases

Getting epidemiology
Epidemiology studies the spread of diseases large population study causes and how to spread their external environment .
Initially , epidemiology was applied only to infectious diseases , but today the concept of epidemiology applies to non-communicable diseases , with widespread in the community.
In everyday speech , the concept of infectious disease almost overlaps that contagious because many infectious diseases are contagious , that can be transmitted in various ways , from person to person or from animal to humans (zoonoses ) . Therefore, in practice, often speaks of infectious diseases .
I. Epidemiology KEY FACTORS

As taught in the prior art ” infectious diseases ” are three main epidemiological factors :
1. source (source) infection
2. transmission routes
3. table responsive
1. Source of infection – is the living organisms ( humans, animals , arthropods ) the pathogen enters and multiplies , sending on different paths.
Elimination of pathogens from sick man , convalescent , chronic carrier is done by :
– Nasopharyngeal secretions and sputum ( in scariatină , diphtheria , whooping cough , measles , etc.).
– vomiting
– Feces (hepatitis A and E, typhoid fever , dysentery , etc. . )
– Urine ( typhoid fever , etc.).
– Genital secretions , semen ( STDs , AIDS) *
– Blood ( viral hepatitis B , C and D , AIDS , malaria , etc.).
– pus (pyoderma , etc. . )
Animals can eliminate germs by:
– Manure ( salmonella)
– Urine ( leptospire )
– saliva
– Milk ( B.K. , some streptococci and staphylococci )
– blood
– meat
– Skin (etc. )
2 . Route of transmission of infectious diseases is of two kinds :
a) direct and b ) indirect
a) Direct transmission can occur through direct contact between receptive and disposer of germs or by direct contact with infectious (infection : blood products – AIDS , HBV ) .
b ) Indirect transmission can occur through the external environment elements (water , air, soil , food, objects , etc. . ) or by agents vectors (flies , cockroaches , fleas , lice , mosquitoes , ticks ) .
The route of transmission was used as a criterion for classification of such contagious diseases :
– Diseases transmitted by direct contact
– Airborne diseases ,
– Digestive Diseases
– Vector-borne diseases
3. Weight responsive
The table responsive means all persons in a community that is not immune to a particular infectious disease . A disease may not appear until the reception. The opposite state of receptivity is resistance to disease . This resistance is natural or artificial ( by immunization ) . This shows the practical importance that the means to fight infectious diseases through immunization of the population, ie artificial modification of immunological status .
Immunity may be:
– Immunity congenital ( by birth )
– Acquired immunity – which can be natural (due to an illness ) or artificial (created by vaccination ) .

II . SECONDARY epidemiological factors

– Nature – weathering
– home
– geographic
– telluric
– Social and economic factors (housing , nutrition , working conditions , rodents , calamities , health culture ) .

III . Manifestations of EPIDEMIOLOGIC PROCESSES

Sporadicitatea = emergence of a small number of diseases in the population ,
Epidemic outbreak of the same disease fa = number of people in a region who have, at least initially, a common source of infection. Diseases with high infectiousness flu, chickenpox, whooping cough , hepatitis , dysentery , etc. . ) .
Endemic = the specific situation in which a disease is permanently in certain territories ( scarlet fever , whooping cough , hepatitis )
= Pandemic infectious disease that spans a large territory (country , continent , everyone – for example, influenza , cholera
After transmission path epidemics :
– Hydro ( with a rapid increase in the number of cases)
– Food ( with sudden outburst all consumers and end also suddenly )
– Vector
– Contact – generally occur in the form of sporadic cases ( for example, sexually transmitted diseases ) .
infectious agents

Pathogenic microorganisms that cause infectious disease are numerous and can be divided into the following groups :

Cocci bacteria :
staphylococci, streptococci , pneumococci , meningococci , gonococci Baciii :
B. diphtheria , b carbon ( b anthracis ) , Escherichia coli ( coli ) , Shigella ( b dysentery, sajmonella ( b typhous ), Klebsiella , Proteus , Pseudomonas b , brucella , ‘ hemophilia Bordettela’pertussis , Clostridium ( b tetanus toxin b ) . thorns :
leptospire , Treponema (T. paliidum ) Mycobacteria : b Koch
Viruses DNA Viruses
– Hepatitis , measles , rabies , smallpox ” herpeto – viruses , adenoviruses ( respiratory agents ) , polio , coxsackie , v. influenza , HIV , etc. .
Ricketts R. prowazekii , R. Quintana ( ” exanthematous fevers ‘ ex ante -matic typhus , Q fever , fever button)

Fungi ( fungus ) Candida ( albicans ) Histoplasma Nocardia Actinomyces
Giardia lamblia protozoa – Trichomonas vaginalis Plasmodium ( malaria )
Entamoeba histolytica ( dysentery amibiană ) Trypanosoma ( sleeping sickness ) Toxoplasma (affecting deeper tissues )
Metazoans Trichinela spiralis ( trichinosis )
M. Mycoplasma pneumoniae ( atypical pneumonia )
Chlamydia Chlamydia trachomatis
( trachoma = granular conjunctivitis ; limfogranulomatoza benigra = b.Nicolas – Favre )
 Defending the body against infections

Defends the body against infectious agents surrounding it, through various means specific and nonspecific.
Normal capacity of the body ‘s defense against infection is called resistance to infection. This natural resistance can be enhanced by active immunized ( vaccination ) and passive immunization ( serums, immunoglobulins) .
Nonspecific and specific Miijoacele which defends the body are: Barrier ” anatomical ( skin and mucous membranes ) of the skin and mucous membranes are a natural barrier against infectious agents by:
– Anatomical integrity .
– Action autosterilizare by: fall superficial cell layer
– The acidic pH of the skin (3 to 5 )
– The pH of acid secretion ( gastric acidity )
– The pH of vaginal discharge
– The acid pH of urine you
Mucosa appears and is given by:
– mucus
– cilia
– Lysozyme – enzyme contained in tears , with bactericidal
Circulating and fixed phagocytes
Phagocytes circulating and fixed phagocytes , tissue incorporates destroy ; pathogenic microorganisms .
• The complement system
The complement system is composed of a group of 18 proteins { after the latest data in the number of 25 ) present in plasma is normally inactivated . If their activation by humoral factors , conferring some power bactericidal blood .
• lymphokines ( cytokines )
Lymphokines ( Cytokines ) are made smaller polypeptide or protein synthesized in particular lymphocytes. These cytokines are part of anti-infective defense ( nonspecific ) . From the list of a part of interferon that can be produced naturally in the body cells infected with viruses (particularly lymphocytes ), or by the action of bacterial endotoxin and other substances known by the action of interferon inducers .
Interferons are produced and in vitro.
The immune system
An important role in anti-infective defense plays with the immune system ‘s two components represented by two types of lymphocytes and B lymphocytes limfociteT
Lymphocytes B = the diferenţierea_limfocitelor mature B cells ( plasma cells ) secrete antibodies of immunoglobulin Ig form , providing humoral immunity .
Mature cells ( plasma cells ) are activated by various factors ( viruses , bacterial antigens , etc. . ) And produce five types of immunoglobulins: IgG , IgM , IgA , IgD , IgE . T cells provide cell-mediated immunity = ..
Like home , they come (and B lymphocytes ) in the bone marrow , after which , however, reach the thymus where they differentiate and specialize in certain activities with functions : role imunoreglator , cytotoxic role .
Lymphocytes with imunoreglator role is divided into several types : lymphocyte T4, T8 ,
Cytotoxic T lymphocytes and so on , killer cells ( Killer T cells ) .
T4 lymphocytes
Their role is to stimulate B lymphocytes in antibody formation . ¬ destroy Gere The T4 lymphocytes . – If their infection with human immunodeficiency virus (HIV ) – it produces profound immunosuppression (very pronounced in AIDS).

T8 lymphocytes
They provide immune homeostasis .
DIAGNOSIS OF INFECTIOUS DISEASES

Pathology diagnosis is based on three main groups of data:
1 . epidemiology .
2 . clinical ( symptoms of dependence )
3. laboratory

epidemiological data

1.Ancheta epidemiological must establish :
• the source of infection.
Questions are asked :
– If there were cases of illness lately and what
– Whether visiting or visited some sick people .
– If he did go.
– If the house was there animals: dogs, cats, rodents , pigs .
• transmission path
– If any food consumed jointly with others and those showed signs of illness.
– If it was in direct contact with any patient with skin lesions
– If handled objects that have been contaminated (wool, animal skins ill)
– If you noticed the presence of flies
– If parenteral treatment did the last 6 months ( for hepatitis B )
• immunological status
– That has suffered from infectious diseases ( of which and when)
– If made ​​vaccinations ( for what disease and when)
It will take into account the secondary epidemiological factors : age , profession, working conditions, housing status , etc. . , And climatic factors ( geographical location , season ) .

CLINICAL

EVENT INFECTION

The interaction of the pathogen with its pathogenic qualities of infectivity , invasion, virulence and host organism through its resistance and reactivity , clinical or biological causes infection events constituting the various clinical forms of severe to mild clinical forms ( vaguely ) .
Infectious process includes:
– Inapparent infection : infection taking place without clinical manifestations are asymptomatic. It highlights only by laboratory tests . Inapparent infection has an acute evolving cyclical followed by immunity.
Example: polio ( one form apparent / inapparent 200 ) measles , diphtheria , meningococcal infection , etc. . Unapparent infections are responsible for immunizations occult population.
– Subclinical disease has no clinical expression . It is characterized by the presence of functional changes and organ damage evidenced by laboratory tests and evolve with chronic complications .
Example: subclinical and anicteric forms of hepatitis . Diagnosis is only at the stage of epidemiological studies or sequelae . Their detection is important in epidemiologically the source of infection , and for being sick cause complications or chronic .
– Asymptomatic latent infection is an infection that can become clinically evident after varying intervals of time , with the involvement of latent infection favorizanţi.Tipuri factors : the wound tetanus , amoebiasis , tuberculosis , brucellosis , herpes zoster .
– Viral disease develops slowly . It is characterized by slowly progressive and progressive damage SNC.Exemplu : Kuru disease , Creutzfeld – Jakob disease , subacute sclerosing panencephalitis .
– Local infection caused by the pathogen multiplication in place of entry or in its vicinity . Example: abscess , phlegmon , boil , pimple malignant ) . Evolves towards healing , chronic , regional or generalized propagation .
– Infection of the outbreak is a particular form of local infection , characterized by minimal local events , but events toxicoseptic general type , occurring on land sensitized . Determine remote complications : RAA , nephritis , septicemia .
– Regional infection is an infection that exceeds the gate , extending to regional lymph nodes and lymphatic territory satelit.Exemplu : Aden lymphangitis .
– Infection is a chronic form of infection in which the pathogen persists in the body causing clinical or biologice.De eg chronic hepatitis, brucellosis
– Status carriers of germs. People mainly put germs in the body after passing through illness manifesting as convalescent carrier or carriers as healthy people healthy , porting the short term ( temporary ) or long term (chronic ) .
– General infectious disease is the most frequent manifestation of the disease characterized by the development infecţioase.Se predictable leg relatively constant characteristic of each disease : incubation onset period state of decline, recovering . Evolution is self-limiting .
– Forms of the system is characterized by an uneven development , unpredictable , usually severă.Exemplu septicemia .
Independent events :
– The patient conscious
– Mobility preserved
– Effective communication at motor.
Sources of difficulty:
– Psychological (stress, anxiety )
– Social (isolation , poverty )
– Lack of knowledge

Events dependency ( Signs and symptoms of infectious diseases )

Infectious diseases – other than the fact that they are easily transmitted from one individual to another , are characterized by the fact that they have a clinical course similar cyclical .
This clinical course comprises several distinct periods :
– The incubation time = time interval of entering the microbe by the appearance of the first body and
symptoms.
– The debut = first signs of disease
– The development of the entire state = symptomatology of the disease
– convalescence = regression of symptoms , the body’s healing period .
During the state all manifestations of addiction reached its peak, are present :
– Some general infection symptoms
– Some symptoms of diseases or groups of diseases
We could meet at this stage the following syndromes :

A febrile syndrome
a continuous fever – high temperature is 39 ° -40 ° C, with little variation between morning and evening , 0.5 ° -1 ° C ( typhoid fever, typhus , pneumonia )
b remitting fever – characterized by fever greater oscillations between 37 ° and 39 ° C, with the minimum temperature falling below 37 ° C ( suppurative infection – staphylococcus , streptococcus )
C. Intermittent fever – with large fluctuations in temperature 36.5 ° -40 ° C occurring daily or afebrile period one or two days between febrile seizures ( malaria , sepsis ) . in this type of fever, minimum temperature reaches normal values ​​.
d.Febra recurring – we febrile periods with continuous temperature (39 ° -40 ° C) for four to six days interspersed afebrile periods of the same duration .
e.Febra undulant – febrile period the temperature rises slowly and keep the set – 38 ° -39 ° C – for 7-10 days lysis decreases after a period afebrile , febrile wave repeats ( brucellosis ) .
f.Febra the inverse – the minimum temperature recorded in the evening and the morning maximum temperature ( pulmonary tuberculosis )
In the febrile syndrome (where fever is the main symptom ) are other disorders ( symptoms of dependence )
– Fatigue , loss of appetite , nausea , headache, dizziness, cold sores , seizures (common in children) , delirium , impaired metabolism of the cardiovascular , renal , respiratory, excretory and secretory functions of
During sindromulului fever there is a disproportionate increase in combustion processes with increased need for oxygen and enhance the elimination of carbon dioxide , which explains polipnee .
Disruption of electrolyte metabolism – leads to dehydration, acid-base balance disorders ( metabolic acidosis )
In parallel with increase in temperature – there is a tachycardia .
There are some diseases where there is this line but there is a relative bradycardia (eg typhoid ) .

B. infectious syndrome and meningian :
foot – high 39 ° -40 ° C , chills
– vomiting
– headache
– cutaneous hyperesthesia
– photophobia
Meningian syndrome are characteristic signs of muscle stiffness :
, neck stiffness ( resistance to trying flectare head )
– sometimes – opistotonus
attitude of ” cock of the rifle ” ( lying on the side , crouching with knees to chest and neck in extension )
– Kernig sign ( inability of the patient to fully stretch your legs , trunk flexion reflex leads to flexion of the knee )
– sign Brudzinscki ( flectarea head lead to knee flexion reflex )
C. encephalitic syndrome :
general infection – signs : high fever 39 ° -40 ° C, frisonete , dizziness , vertigo
– cortical signs : restlessness , delirium , hallucinations , drowsiness deep , often convulsive state , or comatose state semicomatoasă
D. eruptive syndrome :

Cutaneous manifestations ( exanthema )
– Macules , papules , vesicles , pustules , bubbles, petechial bleeding , jaundice
We also meet secondary lesions : scaling , crusting , ulceration, scarring, pigmentation .
Other symptoms: Filatov mask ( in scarlet fever ) , facies whining ( the measles ) , liver mask
Changes in mucosal ( oro -pharyngeal enantemul . )
It will be observed :
– the distribution of the eruption ( generalized , but under certain regions)
– eruption dynamics ( how and where it appears ? whether Streak ?)
E. gastrointestinal syndrome :
Bowel disorders :
– vomiting
– diarrhea ( watery , mucous , muco – bloody etc . )
– tenesmus

Other signs of addiction :

In some diseases such as influenza , measles – upper respiratory catarrhal phenomena
In a large group ( scarlet fever , diphtheria , etc. . ) – Angina different aspect

Signs of the circulatory system : may occur :
peripheral – collapse :
– the water loss (vomiting , diarrhea , sweating )
– by massive blood loss ( postpartum sepsis or post -abortion )
– toxic to the central nervous system of various medicinal substances
– by the action of microbial toxins ( food poisoning , dysentery , etc. . )
symptoms of peripheral collapse , hypotension, hypothermia , skin pale – yellow earthy , cyanosis of the extremities, very fast pulse
Severe and frequent complication of infectious diseases is infecfios shock . This can occur by direct action of microbes and / or microbial toxins . Following a therapeutic act may occur transfusion or anaphylactic shock .

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