Infectious diseases and their causes

PART I

 

INFECTIOUS DISEASES AND THEIR CAUSES

Infectious diseases are caused by pathogenic microorganisms (such as viruses, bacteria, protozoa or fungi that multiply in the body and have a harmful effect on it. These organisms are capable of producing poisonous substances, or toxins, that poison the body.

The causative agents enter the body in a variety of ways, multiply and disrupt normal cell function. Some of them are breathed or swallowed in food and water, others may penetrate through a break in the skin or be transmitted during sexual contact. An infection may spread throughout the body affecting several organs at once. However certain infecting agents target and damage only one particular organ or part of body such as respiratory tract, liver, intestine or kidney.

According to the mode of infection contagious diseases may be classified as:

I.    Infectious diseases in which the infecting organism penetrates through an abrasion or wound of the skin or mucous membranes. Such are, for example, pyogenic bacteria, causing septicemia, gonococcus infection, toxemia.

II. Infections caused by the pathogenic microorganisms through the respiratory tract are: a) diseases due to various types of streptococci: rheumatic fever, quinzy, scarlet fever; b) diseases due to filtrable viruses: measles, mumps, smallpox, chicken-pox, poliomyelitis.

III. Infections, generally bacterial, disseminated principally by the intestinal discharge, such as typhoid fever, dysentery, cholera.

 

VIRUSES

Viruses are the smallest infectious organisms, they consist of a single or double strand of genetic material surrounded by a protein shell. Some types of viruses also have a protective outer envelope. Viruses are only capable to reproduction inside the living (host) cells they invade. The genetic material of the virus reproduces, using the substances from inside the cell. The newly formed viruses destroy the host cell and leave it to find a new host cell to multiply.

 

BACTERIA

Bacteria are microscopic unicellular organisms that are found in our environment. There are thousands of different types of bacteria but relatively few of them cause diseases in humans. Bacteria have a variety of shapes and sizes. They are classified as cocci (spheres), bacilli (rods) and spirochetes. Most of bacteria may cause a disease by producing poisonous chemicals known as toxins. These chemicals can destroy specific body cells or enter the cells and alter their chemical processes. Some bacteria damage the cells in the human body by directly invading them and reproducing inside. Then they break the cell’s membrane and burst out.

 

IDENTIFYING THE CAUSE

In order to identify the causative microorganism bacteriological studies are performed which help to detect such microorganisms by direct examination under the microscope of the patient’s blood, urine, stools, sputum or of any pathological material withdrawn from the body. The examination of the exudate on the tonsils, for example, may reveal the presence of the diphtheria bacillus; examination of the sputum may show the tubercle bacillus.

The direct identification of the infecting agent being impossible, the serologic method is used. The latter depends upon the demonstration in the patient’s serum of antibodies specific to the suspected disease. Special serologic tests have been devised for demonstrating the presence of these antibodies. The method of immunofluorescence consisting of detecting specific antigens in the material studied by means of luminescent microscopy has proved of great diagnostic value.

Exercises

I.    Using the words given below fill in the gaps in the sentences:

1. Influenza is an....

2. Influenza is....

3. Children... with influenza get treatment at home.

4. The... agent penetrates through the skin.

5. You may... the wound if you do not dress it.

6. Pneumonia is an acute... disease.

7. This... is transmitted through the air.

8. The diseases caused by viruses and bacteria are called ….

9. An … child should stay at home.

10. There are many various viruses … people.

11. … diseases are also known as ….

Infect, infectious, infection, infecting, infected.

II. Compare the sentences and say in which way they differ in their sense (translation) and grammar:

1.

a) Infections caused by the pathogenic microorganisms include two types of diseases.

b) These infections are caused by the pathogenic microorganisms.

c) Some infections may be caused by viruses.

2.

a) Bacteriological studies performed to detect the causative microorganism gave positive results.

b) Bacteriological studies were performed in order to detect the causative microorganisms.

c) Bacteriological studies have been performed in order to detect the causative microorganisms.

 

AN INFECTION COURSE

The characteristic feature of acute infectious diseases is their cyclic course. There are clearly defined stages in the course of infectious diseases: incubation (latent period), prodromal period, invasion period, active period, period of decline, convalescence.

The incubation period is the time between the date of exposure to the disease and the beginning of clinical manifestations. The usual incubation period of some communicable diseases, e.g., chicken-pox, measles, scarlet fever, small-pox, whooping cough, ranges between 7 to 21 days.

Any infection may cause temperature 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 quantitiy of fluidbecause most generalized infections are associated with temperature elevation and profuse sweating. Furthermore, a large amount of fluid tends to dilute the toxins produced by the bacteria.

Bed rest and prompt treatment of minor infections such 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 could 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.

 

IMMUNITY

Infections are more likely to develop if the number of infecting organisms is large enough, or if a person’s resistance to disease is reduced. Reduced resistance, or lowered immunity, may be due to weakened immune system (in very young and old population or after a serious disease), to a poor nutrition or to the environment.

Immunity may be natural and acquired. Natural immunity to certain infections may be transmitted from parent to offspring. A temporary passive immunity is transmitted from the mother to her infant both through the placental circulation and through the breast milk. Nowadays most serious infections can be treated effectively and a lot of them may also be prevented by immunization. Over the last century the control of infections has seriously advanced, largely due to improvement in diet, housing and hygiene. Acquired immunity may follow a spontaneous attack of disease, the artificial inoculation of a modified virus, vaccine injections, injections of antitoxic and antibacterial sera.

The most significant primary preventive measure is immunization against contagious diseases. Prophylactic measures applied in early childhood and the preschool age should be directed at combating acute childhood infections.

The medical science is now armed with reliable weapons for preventing infectious diseases. The treatment of infectious disease includes the methods directed against the causative agent and its toxins, as well as the microbes of the secondary complication (treatment with sera, sulfa drugs, antibiotics), and the methods which favourably influence the reactivity of the organism and the patient’s emotional tone (blood transfusion, administration of blood plasma and serum, gamma globulin, physiotherapy, etc.). In addition, the complex of pathogenic therapy includes setting up a hygienic atmosphere for the patient, good care and a proper diet.

 

IMMUNITY 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 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.

 

Exercises

I.    Match the Latin words with their English equivalents and translate them into Russian:

L. Casus    E. a course

Cursus      a case

Causa       a cause

II.  Complete the sentences according to the following model:

First father looks after his child and then the father... (to look after, his child).

First the father looks after his child and then the father is looked after by his child.

1. First the chief nurse instructs the other nurses and then she... (to instruct, the doctor).

2. First the manager checks up the workers and then he... (to check up, the director).

3. First the little boy feeds his dog and then he … (to feed, his mother).

4. The mother cares for her children and when she is ill she... (to care for, they).

 

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.

 

INFLUENZA AND COMMON COLD

Both the flu and common cold are acute upper respiratory infections. They are caused by many kinds of viruses. The diseases spread very quickly by droplet infection during coughing, sneezing or talking. Adults are affected as well as children. The incubation period is short: from a few hours to three days. The main predisposing factors are wet and cold weather, draughts and contact with infected people.

The onset is sudden in case of the flu. It starts with chill, high temperature, bad headache and pains in joints and muscles. Dry cough, sneezing, cold in the head and sore throat may come later. In contrast, common cold begins gradually with catarrhal symptoms: sore throat, dry cough, running nose and “crying” eyes. Adults may have sub-febrile or normal temperature, but in children fever is usually high. With the onset of symptoms the patient should go to bed. He should stay in bed until the temperature becomes normal.

Proper nursing includes bed rest, plenty of warm drink. The patient’s room should be constantly aired. Keeping warm gives some relief.

The flu is a dangerous disease that may lead to such complications as bronchitis, pneumonia, myocarditis and otitis media, typical of children. As a rule, common cold is not so serious. The treatment of both illnesses is similar. There are two ways. Some doctors prefer modern anti-viral drugs like arbidolor others. Traditional medicine like “antigrippin” is widely used. It combines the remedies lowering fever and inflammation (paracetamol) with vitamin C and sometimes anti-allergic drugs. Various similar foreign combinations like Teraflu or Coldrexwork in the same way making the symptoms easier. Herbal and homeopathic remedies can also relieve the patient’s condition.

Vaccination is strongly recommended nowadays not only to prevent any influenza epidemics, but also to protect people from severe complicated cases of an upper respiratory infection with other viruses.

 

Words to be memorized:

Nouns: disease, onset, chill, headache, pain, sore throat, sneezing, cold, cold in the head, cough, recovery, death, treatment, severity, remedy, case.

Verbs: to cause, to stay, to occur, to depend (on, upon), to air, to relieve, to affect.

Adjectives: acute, dangerous, numerous, mild, severe, proper, common.

Exercises

I. Answer the following questions:

1. What kind of disease is influenza?

2. What is influenza (common cold) caused by?

3. How long does the incubation period last?

4. How does influenza (common cold) begin?

5. Does the disease affect only children?

6. What are the main symptoms of influenza? Of common cold?

7. What complications may this disease have?

8. What must the patient do when the symptoms begin?

9. What does the treatment of this disease depend on?

10. What remedies may relieve the patient’s condition?

11. What remedies are used for treatment of influenza (common cold)?

II. Match the underlined words and their Russian equivalents:

1. The onset of the disease is sudden,                       а) поменьшей мере

2. As to treatment                                           b) тяжесть

3. it depends on the severity of disease,                    с)  начало, наступление

4. The child recovered rapidly                          d) озноб

5. He must stay in bed for at least three days           e) что касается

6. The patient may have a chill when he has a high temperature.     f) быстро

III. Find the sentences where “to be” may be translated as “ должен ”:

1. The pathogenic microbes were to be tested in our laboratory.

2. The pathogenic microbes were tested in our laboratory.

3. Infectious diseases are to be differentiated from other ones.

4. Infectious diseases are not easily differentiated from others.

5. The drug was to be forbidden.

6. The drug was forbidden by the Pharmaceutic Committee.

IV. Choose the correct verb form:

1. The infection … (has, has to) spread over a large area.

2. The infection … (has, has to) be eliminated as quickly as possible.

3. The epidemiologist … (had, had to) the possibility to visit the area of infection.

4. The epidemiologist … (had, had to) visit the area of infection to study it at the spot.

5. The pathologic agent … (will have, will have to) be isolated by the end of the week.

6. The pathologic agent … (will have, will have to) been isolated by the end of the week.

V. Fill in the gaps with English equivalents to «может», «должен»:

At about 2 o’clock on a cold winter morning a man telephoned a doctor and asked him if he … come at once. “You … hurry”, he added. The doctor drove seven miles in answer to this call. When he reached the place the man who had called him said, “Doc, I overtired myself. I have not got any pain, but I have a terrible feeling that I … die soon. The doctor examined the patient, felt his pulse and took his temperature. “Have you made your will (завещание)?” he asked. “Why, no, Doctor”, the man looked frightened. “You … have done it long ago”, said the doctor. “Have you got a family?” “Yes”, said the patient. “You … send for them immediately, and your parents … be called, too.” “I say, Doc, do you think I am going to die?” “No, I don’t”, responded the doctor, “but I don’t want to be the only man you have made a fool of on the night like this”.

VI. Complete the sentences:

1. The room must be constantly ….

2. The disease... rapidly.

3. The onset is....

4. In a mild case... is the rule.

5. Death may....

6.... nursing is very important.

7. The disease may have numerous and... complications.

VIII. Read the following texts and say what new information they contain as compared with the previous text:

a)   The onset of influenza is acute, without marked prodromal symptoms, with a rapid rise in temperature and general symptoms. Intense headaches, mainly in the region of the forehead, eyes and temples are characteristic. Children are irritable, sometimes apathetic; they have sleep and appetite disturbances. Vomiting and nosebleed are frequent. In some cases the upper respiratory tract is affected and catarrh of the mucous membranes begins.

b)   Seasonal upper respiratory catarrh is one of the most widespread children’s diseases, which occurs everywhere and affects children of all ages, particularly frequently very young ones. The cases increase during the cold time of the year possibly because children stay less outdoors and therefore do not get enough fresh air, but get greater contact with patients and carriers of bacilli.

VIII. Retell this text in English:

Грипп – самая распространённая заразная болезнь, отличающаяся разнообразием проявлений и многочисленными осложнениями. Грипп передаётся от больного к здоровому и поражает и взрослых и детей в любое время года. Инкубационный период ериппа очень короткий, от нескольких часов до двух суток. Эпидемии гриппа повторяются довольно часто (через два-три года), но периодически они принимают огромные размеры и охватывают всё население земного шара (так называемые пандемии). В 20 веке были две такие пандемии: в 1918-19 гг. пандемия гриппа (так называемая «испанка») охватила все страны света, в результате погибло 20 млн человек. Вторая пандемия имела место в 1957 г., тогда количество заболевших во всём мире было также очень велико, но число смертных случаев было сравнительно небольшим.

Возбудителем гриппа являются вирусы. Известно несколько видов гриппозных вирусов. Вирус гриппа, находящийся на слизистых оболочках носа, рта и глотки больного, при чихании, кашле и разговоре попадает в воздух вместе с капельками слюны или носовой слизи, т.е. заражение происходит воздушно-капельным путём. В крови людей, перенёсших грипп, вырабатываются особые вещества (так называемые защитные тела), которые в течение некоторого срока (1 – 2 года) обуславливают иммунитет организма к новому заболеванию данным типом вируса.

IX. 1. Speak about the difference between influenza and common cold.

      2. Say what is similar in influenza and common cold.

      3.Tell your groupmates how you were ill with influenza.

      a) When was it? Did you have to call a doctor? What did he recommend or administer?

      b) Have any of your relatives had common cold? What did they complain of? How did they try to improve their condition?

      c) Speak of preventing influenza. What precautions should you take during an epidemics?

 

PNEUMONIA

Pneumonia is a specific acute respiratory disease which involves an entire lung or a part of a lung. It may occur at any time of year, but it is frequent in the months of damp and chilly weather.

Factors that predispose to pneumonia include exposure to smoking, malnutrition, asthma, chronic kidney or liver disease. Bottle-fed infants are at additional risk as compared to those breast-fed.

Pneumonia is usually caused by viruses or bacteria. Mixed infections with both viruses and bacteria may often occur. The disease is airborne, spreading during coughing or sneezing. Lungs may also become infected if viruses or bacteria present in the child’s nose or throat get breathed into the lungs.

Bacterial and viral cases of pneumonia are usually present with similar symptoms.

The disease sets in abruptly, often after a preceding upper respiratory infection with a cough. The main symptoms are chill, fever, general weakness and persistent dry cough which can’t be relieved by common measures. The typical signs in children under five are fever, cough, and fast or difficult breathing.The child usually has poor appetite, disturbed sleep. Sometimes children have local chest pains or stomachache. Young infants suffer from shortness of breath.

Pneumonia is typically diagnosed by a combination of physical signs and a chest X-ray.

A variety of complications may occur. Sometimes empyema develops after the seventh day of the disease. Otitis media and mastoiditis are usually found in children. Other complications are pleuritis, lung abscess, acute cardio-pulmonary failure, endocarditis, myocarditis, meningitis, sepsis, a toxic shock etc.

Proper nursing should include bed rest, fresh air and nutritious food. The disease responds very well to specific medication with appropriate antibiotics (amoxicillin etc). Different cough syrups or herbs can relieve cough. Mustard plasters are always administered, sometimes cups as well. The child should be given vitamins C, A and others.

Prevention includes vaccination, environmental measures and proper treatment of other health problems.

Vaccination can prevent certain bacterial and viral types of pneumonia, both in children and adults.

 

SOME FACTS ON PNEUMONIA

Pneumonia is a form of acute respiratory infection involving lungs. Pneumonia is an inflammatory condition affecting primarily the minute air sacs known as alveoli. In a healthy person alveoli are filled with air. In pneumonia they are filled with fluid and pus making breathing painful and limiting oxygen supply.

It is the cause of death of 15% of children under 5 all over the world. It can be caused by such bacteria as:

· streptococcus pneumonia е, it isthe most common cause of bacterial pneumonia in children;

· haemophilus influenzae type b (Hib), it is the second most frequent cause of bacterial pneumonia;

· respiratory- cinticial virus, it is a common cause of viral pneumonia;

·  in HIV-infected children one of the most common causes of pneumonia is pneumocystis jiroveci.

There are several waysof the spread of infection. Some viruses or bacteria may be present in the child’s nose or throat. Sometimes they get to the lungs with the air breathed in, and so infect the alveoli in the lungs. The microorganisms are transmitted by droplet infection from a sick person with cough or sneezing. Pneumonia can be transmitted through blood, especially in childbirth.

Upper respiratory infections (measles as well) may be complicated by pneumonia. The child susceptibility to pneumonia increases under the following conditions:

· Air indoors contaminated with cooking;

· Living in overcrowded setting;

· Parents smoling;

· Unbalanced nutrition;

· Chronic disease of an inner organ;

· Bottle-fed infants are at additional risk as compared to those breast-fed.

Young infants may become unconscious and have convulsions in severe cases of pneumonia.

Pneumonia is typically diagnosed on the basis of a combination of physical signs and a chest X-ray.

The World Health Organisation has defined pneumonia in children clinically based on either a cough accompanied by high temperature or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness.

Prevention includes vaccination (against Hib, pneumococcus, measles, and whooping cough), environmental measures and appropriate treatment of other health problems.

 

Words to be memorized:

Nouns: fever, chill, lung, chest, stomachache, weakness, sweating, expectoration.

Verbs: to involve, to set in, to complicate, to last, to consist, to administer, to remain.

Adjectives: entire, frequent, chief=main, nutritious, common.

Other words: abruptly, chiefly.

Exercises

I. Answer the following questions:

1. What kind of disease is pneumonia?

2. In what seasons does it occur?

3. What are the chief predisposing factors to this disease?

4. What are the main symptoms of pneumonia?

5. How long does it last?

6. Are there any complications after pneumonia?

7. What is the commonest complication?

8. What does the treatment of pneumonia consist of?

9. What medicine is prescribed for pneumonia?

10. What procedures are administered for severe cases of pneumonia?

11. When are vitamins given to the pneumonia patient?

12. What diseases are complicated by pneumonia?

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

Pneumonia almost always sets in abruptly with a high fever. Children often complain of stomachaches and pain in the chest. Sometimes children expectorate bloody sputum. The cough is at first very mild, in some cases it is absent altogether. Respiration is accelerated. The disease lasts 7-14 days. In older children complications are rare, and prognosis is very good. Proper treatment and nutrition lead to complete recovery.

III. Match the underlined words with their Russian equivalents and translate the sentences:

1. This food is very nutritious.                             а) частый

2. The disease sets in abruptly.                                      b) корь

3. During this season the disease is very frequent.              с) резко, внезапно

4. Pneumonia may complicate whooping cough.       e) коклюш

5. Measles may also be complicated by pneumonia.          d) питательный

IV  Speak about: a) symptoms and course of pneumonia; b) complications of pneumonia; c) treatment of pneumonia; d) care for a pneumonia patient.

CHICKEN-POX

Chicken-pox is a very contagious disease of children. The disease occurs in epidemics, especially in children under the age of ten years. Children of the first four years of life are the most susceptible. Chickenpox is also contagious to adults who haven’t had the disease or have not been vaccinated against it. Today a vaccine is available that protects children against chickenpox.

Chickenpox is caused by the varicella-zoster virus (the Herpes virus family). The disease is airborne, the virus spreads during coughing, sneezing or talking getting on the mucous membranes of the nose, mouth or throat.

There is an incubation period of 14—21 days, most frequently 17 days.

The first symptoms are the following: a slight fever, headache and sometimes pains in the back and legs. Almost at the same time with the first symptoms (within twenty four hours) a characteristic eruption appears on different parts of the body. It is found very frequently on the scalp (the hairy part of the head).

The virus causes an itchy rash with small, fluid-filled blisters. The eruption starts as red macules quickly progressing to papules and vesicles. Soon they become crusted. The brownish crusts dry up and the scabs scale in two – three weeks. The child becomes infectious 2 days before the appearance of the rash and remains infectious 5-7 days after that.

The number of vesicles may be very variable. In a mild case the child may have only several vesicles, but sometimes, in severe cases their number may amount to several hundred.

In the majority of cases there is no difficulty in making a diagnosis, but a doctor must learn to differentiate chicken pox from other skin disorders.

Chicken-pox is one of the mildest of acute infectious diseases of children. Children remain feverish for 2 – 3 days, while new vesicles still appear, and after that they feel well. The recovery is usually complete. Complications are rare.

In patients with weak immunity the disease is complicated by stomatitis with little ulcers, pyodermatitis, as well as bacterial infections of the skin, rarely affecting softe tissues, bones or even causing sepsis. Encephalitis may occur in uncommonly severe cases. Isolation is necessary to protect other children from infection. The child should stay in bed as long as he has any fever while new eruption continues to appear.

In the majority of cases no medicine is required for treatment. The lesions should be treated with a disinfective solution (e.g. brilliant green).

 

Words to be memorized:

Nouns: vomiting, eruption, vesicles, crust, scab, disorder, complication, lesion.

Verbs: to appear, to amount, to dry up, to fall off, to scale, to include, to require.

Adjectives: contagious, susceptible, slight, brownish, variable, severe, complete, rare, eruptive, common.

Other words and expressions: frequently, almost.

 

Exercises

I. Answer the following questions:

1. What kind of disease is chicken-pox?

2. What is the most characteristic symptom?

3. What age is affected by the disease?

4. Is the incubation period long?

5. What are the first symptoms?

6. When does the eruption appear?

7. What does the eruption consist of?

8. On what part of the body does the eruption appear?

9. How many vesicles may be on the skin?

10. What is the duration of this disease?

11. What treatment is required?

12. Is it difficult to make a diagnosis?

13. What must the doctor keep in mind making a diagnosis?

14. Is chicken-pox usually mild or severe? What shows this?

II.  Translate the following sentenses:

a) 1. No special treatment is required in case of chicken-pox.

2. Chicken-pox does not occur in vaccinated adults.

3. Chicken-pox is not a dangerous disease.

4. The doctor found no eruption on the back of the patient.

5. The sick boy did not attend school during 5 days.

6. As a rule chicken-pox has no complications.

7. The patient was not taken to the hospital because he had no symptoms of any infectious disease.

8. The patient had no symptoms of scarlet fever. There was no rash on his neck, chest or extremities.

9. The child felt no pain in the throat.

 

b) 1. There should be an immunity after a spontaneous attack of chicken-pox.

2. There may or may not be a preceding upper respiratory infection with cough.

3. In a mild case of chicken-pox there may be eight or ten vesicles, but in a severe case there may be six or seven hundred of them.

4. There may occur such complications as nephritis, pneumonia and encephalitis.

5. If there is chicken-pox, there must be skin eruption.

 

c) 1. Chicken-pox is known to be transmitted by droplets.

2. Treatment of chicken-pox must be aimed at controlling the fever and relieving the itching.

3. Where is Dr.Brown? He may be examining a child with some rash admitted to the hospital.

4. She must have been treated in hospital because of the severe complication after chicken-pox.

5. Chicken-pox may be a serious disease for adults who may have been infected with AIDS; it may be treated with ciclovir.

VARICELLA ZOSTER VIRUS

Varicella zoster virus is an exclusively human virus and is highly infectious. Primary infection leads to acute varicella or “chickenpox”, usually from exposure either through direct contact with a skin lesion or through airborne spread from respiratory droplets.

Primary varicella typically presents with fever, constitutional symptoms and a vesicular, pruritic, widely disseminated rash that primarily involves the trunk and face. The symptoms usually resolve within 7 to 10 days, but in rare cases leads to more severe disease and visceral invasion.

Treatment options are based on the patient’s age, immune state, duration of symptoms and presentation. Antiviral medications decrease the duration of symptoms and the likelihood of postherpetic neuralgia, especially when initiated within 2 days of the onset rash. In typical cases that involve individuals, who are otherwise healthy, oral acyclovir may be prescribed.

 

CHICKENPOX IN ADULTS

Those who have never had chickenpox as a child or who have not been vaccinated against it are at risk of catching it as an adult. The symptoms for adult chickenpox are often more severe and come with possible added complications. You are also at a greater risk of catching chickenpox if:

· You live with a child who has not been vaccinated against chickenpox.

· You come into contact with the spots of someone suffering from chickenpox.

· You share items with someone who has chickenpox (eg. towels, clothes bedding).

· You work in an environment with a large number of children (such as school or nursery).

There are additional risk factors too. People with impaired immunity such as smokers and pregnant women also have an increased risk of contracting the virus. Red spots are the most obvious symptom. In the days prior to the spots appearing some people also experience other symptoms, including a high temperature (over 38°C), generally feeling lethargic and unwell, and a loss of appetite. Similar to children chickenpox in adults usually starts around 10 to 21 days after being exposed to virus. New spots usually appear for around 7 days and will usually scab over after 10 to 14 days. Cooling creams and/or gels can help to ease the itching. Take paracetamol, drink lots of fluids to keep hydrated, wear loose-lifting clothes and take a bath in tepid water. Adults have a higher chance of developing complication, the most common being pneumonitis (inflammation of the lung tissue). Chickenpox in adults can also cause inflammation of the brain (encephalitis) or an infection in the lungs (pneumonia), although it is rare.

 

SCARLET FEVER

Scarlet fever is an acute contagious disease characterized by high temperature, rapid pulse, a punctate eruption followed by desquamation, inflammation of the throat. It is caused by Hemolitic Streptococcus.

The disease may be transmitted either by various objects infected by the patient (clothing, toys, books and food-stuffs), or by means of droplet infection (during coughing, sneezing or talking).

All children are susceptible, particularly frequently between 18 months and 10 years of age. Adults also contract this illness, however, they suffer from sore throat, but have no eruption characteristic of scarlet fever.

The incubation period of the disease lasts on an average 4 - 7 days; sometimes it only takes a few hours.

The onset of the disease is sudden. The child has generally a very sore throat, nausea, vomiting, headache and often chills. There is a sharp rise of temperature to 39-40°C, the lymphatic nodes of the neck are enlarged. The child is restless and sleeps badly. Within a few hours, but more often at the end of the first or in the beginning of the second day a diffuse red rash appears on the neck, chest and back, spreading to the arms and legs. The area around the mouth remains free from rash. The rash lasts one or three days and then fades away. After the disappearance of the rash the period of desquamation begins. Desquamation continues 10 - 14 days.

The principal complications are acute nephritis, adenitis, otitis media, pericarditis, endocarditis, etc.

Scarlet fever patients should be isolated and stay in bed. Careful disinfection of the patient’s things is important. Antibiotics are prescribed.

Words to be memorized:

Nouns: scarlet fever, rash, neck, desquamation, adult, nausea, illness, inflammation, course, disappearance.

Verbs: to transmit, to contract, to fade away, to spread.

Adjectives: rapid, direct, sudden, sharp, restless, careful.

Other words and expressions: either... or …, by means of, particularly, a few.

Exercises

I.     Answer the following questions:

1. What kind of disease is scarlet fever?

2. What symptoms is it characterized by?

3. How is this disease transmitted?

4. What children are susceptible to scarlet fever?

5. Do adults contract scarlet fever?

6. How long does the incubation period last?

7. How does scarlet fever begin?

8. When and where does the rash appear?

9. How long does the rash last?

10. What is the eruption followed by?

11. What is the most communicable period?

12. What measures must be taken with the appearance of the first symptoms?

13. What are the principal complications?

14. How is this disease treated?

II.  Translate the following sentences:

1. The rash lasts 1 - 3 days and is then followed by desquamation.

2. Serious complications such as nephritis, otitis and affections of the joints may follow any stage of scarlet fever.

3. Even mild cases of scarlet fever may be followed by late complications.

4. In very young children the onset of pneumotia is frequently not associated with any preceding infection (influenza). In other cases case history shows influenza followed by dyspnea.

5. Bronchopneumonia in infancy follows a very diverse course, ranging from cases with a mild form to severe toxic or, septic forms that are frequently followed by grave complications.

III. Read the text:

Say what information is new as compared with the first text about scarlet fever.

Scarlet Fever

In this infection certain Streptococcus bacteria enter the body through the pharynx, or throat, and cause an attack of tonsillitis. Without antibiotic treatment, the bacteria multiply and produce a toxin, or poison, that circulates in the blood. After an incubation period of one to seven days, the amounts of toxin are sufficient to cause the symptoms of scarlet fever.

What are the symptoms?

The symptoms do vary slightly from person to person. Here is a typical case of scarlet fever.

On day one the child develops a high fever (as high as 104 degrees F, or 40 degrees C), a red, sore throat and tonsils, and a furred tongue. Sometimes a whitish coating covers the tonsils and the child may vomit.

On day two a bright red (scarlet) rash appears on the child’s face, except for just around the mouth. By day three this rash, which may itch, has spread to cover the rest of the body and the arms and legs. Meanwhile the child’s temperature starts to fall and the tongue becomes bright, strawberry-red.

By day six the rash has faded. Both skin and tongue may begin to peel, leaving a red, raw surface underneath. Peeling can last another 10 to 14 days.

Scarlet fever now has become rare. The two main risks, both very rare and occurring about two to three weeks after the rash, are rheumatic fever and a form of glomerulonephritis.

Parents of the child should contact the physician if you suspect your child has scarlet fever. Follow the advice of the doctor and you can expect a full recovery with no after-effects.

IV. a) Speak about:

1) the symptoms of scarlet fever

2) the course of the disease;

b) Describe:

1) how scarlet fever is transmitted

2) how eruption appears and spreads.

 

TREATMENT OF SCARLET FEVER

Most mild cases of scarlet fever resolve themselves within a week without treatment. However, treatment is important, as this will accelerate recovery and reduce the risk of complications. Treatment normally involves a 10-day course of oral antibiotics, usually penicillin. The fever will usually go within 12-24 hours of taking the first antibiotic medication and patients normally recover 4 to 5 days after the treatment. Patients who are allergic to penicillin may take erythromycin or another antibiotic instead. It is important to take the full course of antibiotics even if symptoms go away before it is finished. This is not necessary to get rid of the infection and reduce the risk of post-strep disorders developing. Other strategies can help relieve symptoms. The environment should be kept cool. Tylenol or acetaminophen may help relieve aches and pains and reduce the fever. Calamine lotion can help reduce it.

 

TONSILS

The tonsils are masses of lymphoid tissue located in the pharyngeal cavity. The tonsils filter and protect the respiratory and alimentary tracts from invasion by pathogenic organisms. They also play a role in antibody formation. Although the size of tonsils varies, children generally have larger tonsils than adolescents or adults. This difference is thought to be a protective mechanism, since young children are especially susceptible to upper respiratory infections (URIs).

Six tonsils are part of a mass of lymphoid tissue encircling the nasopharynx and oropharynx, known as the Waldeyertonsillar ring. They are the two palatine, or faucial, tonsils (a surface of the palatine tonsils is usually visible during oral examination), the pharyngeal tonsil, also known as the adenoids, the lingual tonsil and the two tubal tonsils.

 

TONSILLITIS/PHARINGITIS

Tonsillitis is a common cause of illness in young children. Tonsillitis often occurs with pharyngitis. The causative agent may be viral or bacterial. 80% to 90% of all cases of acute pharyngitis are viral. The rest are caused by Group A Beta-Hemolytic Streptococcus (GABHS).

The manifestations of tonsillitis/pharyngitis are caused by inflammation.

GABHS infection is generally a relatively brief illness that varies in severity from subclinical (no symptoms) to severe toxicity.

The onset is often abrupt and characterized by pharyngitis, headache, fever, and abdominal pain. The tonsils and pharynx may be inflamed and covered with exudate (50%-80% of cases), which usually appears by the second day of illness. However, streptococcal infections should be suspected in children over the age of 2 years who have pharyngitis even if no exudate is present.

Anterior cervical lymphadenopathy usually occurs early, and the nodes are often tender.

Clinical manifestations of tonsillitis usually subside in 3 to 5 days unless complicated by sinusitis or parapharyngeal, peritonsillar, or retropharyngeal abscess.

 

Scarlet fever may also occur as a result of a strain of group A streptococcus. The clinical manifestations of scarlet fever include pharyngitis/tonsillitis and a characteristic erythematous sandpaper-like rash; otherwise scarlet fever shares the same clinical manifestations as those mentioned for GABHS tonsillitis.

GABHS infection of the upper respiratory airway (strep throat) is not in itself a serious disease, but affected children are at risk for serious sequelae: acute rheumatic fever, which is an inflammatory disease of the heart, joints, and central nervous system, and acute glomerulonephritis, which is an acute kidney infection, may appear after the onset of GABHS – acute nephritis in about 10 days and rheumatic fever in an average of 18 days.

Because the illness is self-limiting, treatment of viral pharyngitis is symptomatic. Nursing care of the child with tonsillitis involves providing comfort and minimizing activities or interventions that precipitate bleeding. A soft to liquid diet is generally preferred. A coolmist vaporizer keeps the mucous membranes moist during periods of mouth breathing. Warm saltwater gargles, warm fluids, throat lozenges, and analgesic-antipyretic drugs such as acetaminophen are useful to promote comfort breathing. Analgesics should be given routinely every 4 hours while symptoms persist.

Cold or warm compresses to the neck may provide relief as well as warm saline gargles. Pain may interfere with oral intake, and the child should not be forced to eat. Instead, encourage cool liquid or ice chips, which are usually more acceptable than solids.

If streptococcal sore throat infection is present, oral penicillin is prescribed. Penicillin in proper dose can also eliminate the organisms that might remain to initiate rheumatic fever symptoms. Some patients require retreatment if the organism is not eradicated. Amoxicillin given once a day for 10 days is just as effective as penicillin. Intramuscular penicillin G benzathine is also an appropriate therapy.

Chronic enlargement of the tonsils and adenoids may result in obstruction of breathing during sleep.

If mouth breathing is continuous, the mucous membranes of the oropharynx become dry and irritated. There may be an offensive mouth odor and impaired sense of taste and smell. Because air cannot be trapped for proper speech sounds, the voice has a nasal and muffled quality. A persistent cough is also common. Because of the proximity of the adenoids to the eustachiantubes, this passageway is frequently blocked by swollen adenoids, interfering with normal drainage and frequently resulting in otitis media or difficulty hearing.

Tonsillectomy (surgical removal of the palatine tonsils) may be indicated for massive hypertrophy that results in difficulty in breathing and eating. Adenoidectomy (surgical removal of the adenoids) is recommended for children who have hypertrophied adenoids that obstruct nasal breathing и при нарушениях слуха.

 

MEASLES

Measles is a highly contagious viral disease that tends to appear in epidemics and mainly affects children. The measles virus is easily transmitted in minute airborne droplets by coughing and sneezing of infected people. A child who has measles may feel very ill after incubation period of 8-15 days, the first symptoms resemble those of a cold (runny nose, hacking cough, sneezing). After 3 days rash may develop accompanied by a high fever. Small red spots with white center known as Filatov-Koplik spots appear on the insides of the cheeks (on the mucous membranes). After 3-4 days a red non-itchy rash starts on the head or behind the ears andspreads to the face and downwards to the whole body. At first the rash consists of separate papules (flat spots) surrounded by red macules, then the spots join forming a blotchy appearance. The rash lasts 3-5 days. During this period the child may have high temperature (up to 39-40 degrees) and painful, red, watery eyes. After the disappearance of the rash desquamation beginswhich leaves pigmented skin for about a week.

Complete recovery may take 2–4 weeks. The most common complications include bacterial infections of the middle ear (acute otitis media) and of the lungs (pneumonia). Severe brain complication (encephalitis) may start 7-10 days after appearance of the rash.

Measles may kill up to 1 million children in the developing world each year but it is rare in our country and developed world because of immunization. Babies are immunized against measles with a special vaccine given at12-15 months and again between 3 and 5 years of age. The immunization or an attack of measles gives a lifelong immunity to the disease.

There is no specific medication for measles. The patient should stay in bed. Proper nursing can prevent complications. The patient’s room must be aired as often as possible and vacuumed clean, because fresh air prevents further infection. The patient’s bed must be placed so that the bright sun 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 candrink boiled water instead of rinsing. As the sick child has poor appetite he should take soft diet in small amounts 5 - 6 times a day. The patient must not be allowed to rub his eyes. The child’s hands should be washed frequently. 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.

Words to be memorized:

Nouns: measles, membrane, limb, nursing, diet, amount, solution, condition.

Verbs: to prevent, to protect, to clean, to place, to darken, to drink, to rinse, to wash out, to isolate, to expose.

Adjectives: widespread, grave, mucous, sick, clean, boiled.

Other words and expressions: 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 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.

Meningococcaemia

Meningococcal septicaemia has 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. Render the information below in English:

Менингококковая инфекция

Менингококковая инфекция – одно из тяжелейших инфекционных заболеваний. Заболевают люди любого возраста, но больше всех страдают дети и молодёжь. В Санкт-Петербурге от этой инфекции ежегодно погибают дети.

Возбудитель – Neisseria meninggitidis, грамотрицательная палочка, неустойчивая во внешней среде. Переносится людьми, особенно опасны 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 нарастает, 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.

 

MEASLES

Causes:

Measles is a highly contagious illness caused by a virus that replicates in the nose and throat of an infected child or adult. Then, when someone with measles coughs, sneezes or talks infected droplets spray into the air where other people can inhale them. The infected droplets may also land on a surface where they remain active and contagious for several hours. You can contract the virus by putting your fingers in your mouth or nose or rubbing your eyes after touching the infected surface.

Risk factors include:

· Being u