INFECTIOUS DISEASES Edited by: prof. E. Nikitin, Honoured Science & Technics Worker of Ukraine, prof. M. Andreychyn Approved by the Central Methodolo- gical Committee of Higher Medical Education as a manual for students of the Higher Medical Schools of the III-IV degree of accreditation (protocol ¹ 2, 30.03.2004) Ternopil Ukrmedknyga 2004 ББК 51.9я73 І 60 УДК 616.9(075.8) Authors: E. Nikitin, M.D., Ph. D.; M. Andreychyn, M.D., Ph. D.; K. Servetskyy, M.D., Ph. D.; V. Kachor, M.D.; A. Holovchenko, M.D.; E. Usychenko, M.D. Колектив авторів: д-р мед. наук, проф. Нікітін Є.В., засл. діяч науки і техніки України, д-р мед. наук, проф. Андрейчин М.А., д-р мед. наук, проф. Сервецький К.Л., канд. мед. наук, доц. Качор В.О., канд. мед. наук, доц. Головченко А.М., канд. мед. наук, доц. Усиченко Є.М. Reviewers: A. Rudenko, Honoured Doctor of Ukraine; I. Sytnyk, M.D., Ph. D.; L. Shevchenko, M.D., Ph. D. Рецензенти: А.О. Руденко, д-р мед. наук, заслужений лікар України; І.О. Сит- ник д-р мед. наук, проф.; Л.Ю. Шевченко, д-р мед. наук, проф. І 60 Інфекційні хвороби: Підручник / Є.В. Нікітін, М.А. Андрейчин, К.Л.Сервець- кий, В.О. Качор, А.М. Головченко, Є.М. Усиченко: За ред. Є.В. Нікітіна та М.А. Андрейчина. – Тернопіль: Укрмедкнига, 2004. – 364 с. ISBN 966-673-012-Х The manual reveals etiology, pathogenesis, clinic, diagnosis, medical treatment, and prophylaxis of widespread infectious diseases considering modern data. The authors of the book generalized experience of this subject being tought at home and foreign medical universities and academies, as well as infectious diseases departments, where they work. Attention is paid to presentation of material, which has important clinical value. This manual corresponds to the program of Ministry of Health of Ukraine and is designed for the students of medical higher education institutions of III-IY accreditation levels. У підручнику, з урахуванням сучасних відомостей, висвітлено етіологію, пато- генез, клініку, діагностику, лікування та профілактику розповсюджених інфекцій- них хвороб. Узагальнено досвід викладання цього предмету у вітчизняних і зарубіж- них медичних університетах та академіях, а також кафедр інфекційних хвороб, на яких працюють автори книги. Акцент зроблено на подання матеріалу, який має важ- ливе клінічне значення. Підручник відповідає програмі, затвердженій Міністерством охорони здоро- в’я України, й адресується студентам медичних навчальних закладів III-IV рівнів акредитації. ББК 51.9я73 УДК 616.9(075.8) ISBN 966-673-012-Х Нікітін Є.В. та ін., 2004 Contents INTRODUCTION OF INFECTIOUS DISEASES ............................................................... 5 THE PRINCIPLES OF THE DIAGNOSTICS, TREATMENT AND PREVENTION OF INFECTIOUS DISEASES............................................................................................... 22 TYPHOID FEVER AND PARATYPHOID ......................................................................... 37 BRUCELLOSIS ....................................................................................................................... 47 SHIGELLOSIS......................................................................................................................... 57 SALMONELLOSIS ................................................................................................................. 67 CHOLERA ............................................................................................................................... 77 BOTULISM. TOXIC FOOD-BORNE DISEASES. CAMPYLOBACTERIOSIS ............ 88 PSEUDOTUBERCULOSIS.................................................................................................... 99 LEPTOSPIROSIS .................................................................................................................. 111 HERPETIC DISEASES ........................................................................................................ 122 ERYSIPELAS. ERYSIPELOTRIX ...................................................................................... 135 ANTHRAX............................................................................................................................. 142 VIRAL HEPATITIS .............................................................................................................. 149 INFLUENZA......................................................................................................................... 163 ACUTE RESPIRATORY VIRAL DISEASES ................................................................... 179 MYCOPLASMA PNEUMONIAE INFECTION .............................................................. 198 MENINGOCOCCAL INFECTION .................................................................................... 202 DIPHTHERIA........................................................................................................................ 216 RICKETTSIOSIS ................................................................................................................... 233 VIRAL ENCEPHALITIS ..................................................................................................... 253 RABIES ................................................................................................................................... 263 TETANUS .............................................................................................................................. 272 MALARIA .............................................................................................................................. 279 PLAGUE ................................................................................................................................ 301 TULAREMIA ........................................................................................................................ 319 AQUIRED IMMUNODEFICIENCY SYNDROME ........................................................ 332 SEPSIS .................................................................................................................................... 352 Literature................................................................................................................................. 364 4 Infectious diseases Introduction of infectious diseases 5 INTRODUCTION OF INFECTIOUS DISEASES Nowadays there are about 2,500 well-known microorganisms that cause infectious diseases. About 300 nosological forms have been distinctly described (“nosos” means “disease” in Greek). According to the international classification the infectious diseases relate to 13 classes and 975 rubrics. They constitute up to 60-70 % of the total morbidity. In polyclinics 4-6 patients out of 10 suffer from infectious diseases. The responsibility for the exposure of the infectious morbidity is taken by the physicians of the “first line” – therapeutists, surgeons, gynecologists and other specialists. Now it is distinctly ascertained that the infectious agents are the basic or leading ethiological factor of the different branches of the medical science. Such fields of the internal diseases as rheumatology, pulmonology or hepatology cannot be conceived without taking into consideration the infectious factor. The infectious factor often determines the outcome of the surgery. The gynecological, urological and eye diseases cannot be treated without considering it. The association of the viral hepatitis B and C with the primary liver cancer is undoubted, there is a certain connection between the cancer of the cervix of the uterus and the virus of the herpes simplex, leucosis and Bercet’s lymphosarcoma. The significance of the infections agents in bronchial asthma, arthritis, meningoencephalitis is undoubted. Besides these many new earlier unknown discuses have appeared. Only during the last years such infections diseases as HIV, Legionnaires disease, cryptosporidiosis, SARS, hemorrhagic fevers, caused by Marburg or Ebola virus, hantavirus and others have appeared, they are responsible for the development of the ulcer disease of the stomach, pneumonia, meningoencephalitis, cutaneous diseases, lymphoadenopathy, heart and vessels diseases. Many researchers think that the world is standing on the verge of the T-cell leucosis epidemic, which is already widely spread in Japan and in some regions of Latin America. That is why a physician of any speciality will more or less often encounter with the infectious pathology. The origin of the infectious diseases dates back from the ancient times. The old archives that contain the man’s first descriptions of his thoughts with the help of signs tell us that he already suffered from such diseases as leprosy, hydrophobia, malaria, trachoma, fungous, helmintic and some other diseases. Although the infectious diseases exist as long as life itself, their studying started comparatively not long ago. It is one of the youngest branches of science. 6 Infectious diseases The scientific history of the infectious diseases started at the end of the 19th century when the term “infectious diseases” was introduced, and it was determined that they were caused by the microorganisms i.e. the organisms that could be found only with the help of a microscope. The common feature of the majority of the infectious diseases is the possibility of transmission from the affected organism to a healthy one, and the ability of massive (epidemic) spreading. During the study of the infectious diseases the terms “infection” and “infectious process” are usually used. They both originate from the Latin words – “infectio”