III. Translate from Russian into English:

1. Сегодня у больной не болит голова.

2. Мой друг сейчас не в больнице, он в санатории.

3. Я не пойду в палату, так как у меня нет халата.

4. У нас вчера не было практики в клинике.

5. Больной не чувствовал никакой боли в пояснице.

6. Я не болел пневмонией в раннем возрасте.

7. У меня не было осложнений после гриппа.

8. Я не буду принимать это лекарство.

9. Врач вчера не оперировал.

10. У нас не будет лекции по анатомии в понедельник.

11. В кабинете врача никого не было.

IV. Read the text and say what new information it contains as compared to the previous text:

In the vast majority of cases of chicken-pox the eruption is the first sign of the disease and the rash is not preceded by a prodromal illness.

Mothers usually state that the first symptom to attract attention was the rash. There may be some mild constitutional symptoms, such as malaise and a slight temperature. These may vary in duration from a few hours to two or three days. The child may appear restless and slightly feverish the night before the rash appears. Adults, on the other hand, are very apt to have a well-defined series of prodromal symptoms, such as chill, fever, nausea, loss of appetite, backache, etc.

V.  a) Speak about the symptoms of chicken-pox.

      b) Describe the period of eruption.

      c) Read what a crust, or a scab, is and explain it in English:

Crust is a formed outer layer especially an outer layer of solid matter formed by the drying of a bodily exudate or secretion; it is also called scab.

 

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.