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1. The patient of M. entered the infectious department for 30 years, with complaints of fever, up to 38-39ºС, headache, weakness, pain in the muscles, throat. The third day is sick. A week ago he bathed in the lake, swallowed water.
Objectively: a person, conjunctives are hyperemic, a bradycardia, heart tones are muffled, hypotension. The liver and spleen are moderately enlarged. Catarrhal tonsillitis on the right, submandibular lymph nodes on the right are enlarged to 5 cm, are of little use. According to the health authorities in the region, there is an epizootic of tularemia among rodents.
Preliminary diagnosis: anginozobubonnaya form of tularemia. What methods of laboratory diagnostics can you offer? The culture of the pathogen could not be distinguished by a bacteriological method. How can this be explained?
After intradermal administration of 0.1 ml of tularin after 48 hours, hyperemia and an infiltrate up to 10 mm in size appeared at the injection site. How to evaluate the result of a skin-allergic test?
The blood-drop reaction agglutination was positive immediately after the addition of tularemia diagnosticum. What does it say?
What serological reactions are necessary to be carried out, their diagnostic titer?
2. A patient with a high temperature of 39 ° C, a chill, a headache was delivered to the infectious hospital. Objectively: the lymph nodes are dense, enlarged and painful. The patient was taken from the countryside endemic for the plague. A preliminary clinical diagnosis was made: bubonic plague. Microscopy of the contents of buboes showed the presence of oval-shaped rods, bipolar stained. However, for the timely adoption of effective anti-epidemic measures, bacteriological confirmation is necessary. The test material was seeded on a cup with Marten's nutrient agar. The crops were incubated at 25-28 ° C during the day. On agar microscopy, colonies in the form of a "lace handkerchief" are marked, and floured growth on the broth. What research needs to be done to identify the selected culture? What tactical error is admitted in the study. Are rapid tests and serological tests used in laboratory diagnostics? What drugs are used to treat and prevent plague? What are the distinguishing features of preventive measures for the prevention of quarantine and especially dangerous infections?
3. Milkmaid M., 40, received complaints about high fever, malaise, appearance of an ulcer on the left forearm, itching and burning in the area of an ulcer. From anamnesis: on the evening before, a red spot appeared on the place of the ulcer, which turned into a papule of copper-red color, and then into a vial full of dark liquid. Objectively: body temperature 39 ° C, on the skin of the left forearm, an ulcer up to 1 cm in diameter, covered with a black crust. The skin around the ulcer is hyperemic and marked. When palpation, the ulcer is painless. Preliminary diagnosis: Anthrax, cutaneous form. In the case of bacterioscopy stained with Gram stain, large gram-positive sticks with chopped ends, located in the form of chains surrounded by a capsule, were found from the separated ulcer. Make a conclusion? How to increase the reliability of the answer? When a bacteriological study of the separated ulcer in the broth, a flocculent precipitate formed. On the MPA, rough R-forms of the colony are marked, resembling the "lion mane" in appearance. On the blood agglutination hemolysis is not marked, microscopically gram-positive capsule-shaped rods that thin the gelatin in the form of an "inverted herringbone". When cultivated on agar with penicillin, the morphology of cells changed - spherical cells formed in the form of a pearl necklace. Are these tests sufficient to identify the pathogen? Which microorganisms should be differentiated from it and how? What additional diagnostic methods can you offer? What drugs are used to treat the prevention and diagnosis of anthrax? Justify the preventive measures for anthrax, taking into account the biological characteristics of the anthrax bacillus.
4. A patient turned to the doctor with complaints about fatigue, irritability, headache, joint and muscle pains. A fever. There is a multiple chill during the day, followed by a profuse sweating. Objectively: the liver and spleen are enlarged. From the analysis: the patient works at a meat-packing plant. A preliminary diagnosis was made: Brucellosis? To confirm the clinical diagnosis: Wright agglutination reaction was given with the serum of the patient, which gave a positive result. What does this indicate, is it possible to give a definitive answer based on the results of the serological reaction? Why are the brucellae rarefied bacteriologically? What diagnostic methods can be used in later periods of the disease? Drugs used to treat the prevention and diagnosis of the disease.
1. Patient N. 20 years old complained of high body temperature up to 38-39ºС, chills, severe headache, insomnia, lack of appetite, thirst, severe muscle pains, especially in the calf muscles. Upon inspection, the
Tests:
1. Protective antigens are found in pathogens
A) typhoid fever
B) gas gangrene
C) plague
D) cholera
E) smallpox
2. Growth of plague pathogen on liquid nutrient medium
A) thin film
B) uniform turbidity
C) solid sediment on the bottom
D) near-bottom growth
E) loose film from which the threads come down
3. Quarantine illness characterized by severe intoxication, fever, lymph node involvement, septicemia, caused by a pathogen
A) plague
B) tularemia
C) brucellosis
D) Anthrax
E) cholera
4. Polymorphic ovoid fixed sticks, synthesizing the capsule at a temperature of 37 ° C, bipolar staining in smears, are pathogens
A) brucellosis
B) tularemia
C) plague
D) Anthrax
E) cholera
5. Gram-negative, ovoid sticks, which are psychrophils, the optimal growth temperature of which is 28 ° C, are pathogens
A) plague
B) tularemia
C) brucellosis
D) Anthrax
E) cholera
6. Gram-negative ovoid bacilli, in which the R-forms of the colony are highly virulent, are pathogens
A) Tularemia
B) plague
C) brucellosis
D) Anthrax
E) cholera
7. Zoonotic disease occurring in bubonic, globose-buffalo, anginal-bubonic and septic forms, the leading method of investigation in which the biological
A) Anthrax
B) the plague
C) Brucellosis
D) Tularemia
E) cholera
8. Zoonotic disease, in which the isolation and identification of the pathogen is carried out after the biological method of investigation
A) Anthrax
B) the plague
C) Brucellosis
D) Tularemia
E) cholera
9. Zoonotic disease, in which specific prevention is carried out with the help of live vaccine, obtained by N. Gaisky and B. Elbert
A) Cholera
B) the plague
C) Brucellosis
D) Anthrax
E) Tularemia
10. Zoonotic disease with long-term fever, defeat of the musculoskeletal system, nervous, cardiovascular and genitourinary systems
A) Brucellosis
B) the plague
C) Tularemia
D) Anthrax
E) Cholera
11. Anthroponous spirochetosis, the main prevention of which is the fight against pediculosis
A) endemic typhus
B) epidemic typhus
C) recurrent typhus
D) Ku fever
E) tick-borne recurrent typhus
12. Anthroponous spirochetosis, diagnosed with the help of a microscopic method, preparations from blood stained by Romanovsky-Giemsa
A) epidemic typhus
B) recurrent typhoid
C) endemic typhus
D) Ku fever
E) tick-borne recurrent typhus
13. What is the pathogenicity of Borrelia of recurrent typhus
A) endotoxin
B) exotoxin
C) capsule
D) saw adhesion
E) enzymes of aggression
14. The route of transmission of infection with recurrent typhoid
A) food
B) transmissible
C) airborne
D) contact-household
E) sexual
Lesson№ 9
1. Topic: Clinical microbiology. MDD of nosocomial infections. (stages of the bacteriological method).
Midterm Exam
2. Aim: To familiarize students with the subject and tasks of clinical microbiology and their role in the practical work of a medical worker necessary for the proper organization of microbiological laboratories and the observance of sanitary and hygienic standards in medical and preventive institutions. Checking and assessing the level of residual knowledge among students.
3. Objectives: Give general concepts of clinical microbiology. Checking and assessing the level of residual knowledge among students.
4. Main questions of the topic:
1. Definition of the subject of clinical microbiology.
2. Modern methods of research.
3. Tasks of clinical microbiology.
4. Microbiological methods of diagnosis.
5. Immunological methods of diagnosis
6. What microorganisms do we call conditionally pathogenic microorganisms?
7. List the UPM. The role of opportunistic microorganisms in the human body.
8. Role of UPM in infectious pathology. The role of conditionally pathogenic microorganisms in VBI.
9. Rules for the sampling of the test material. Rules for storage and transportation of the material under investigation.
10. What factors contribute to the emergence of VBI. Etiology of VBI.
11. Causes of the emergence of antibiotic-resistant strains of microorganisms. Treatment and prevention of VBI.
12. Importance of clinical microbiology in a practical physician
5. Methods of learning and teaching: Tests that include IFOM questions, oral interviews and situational tasks
6. Literature:
Basic:
1. Vorobiev AA, Krivoshein Yu.S., Shirobokov V.P. Medical and Sanitary Microbiology M .: Publishing Center "Academy" - 2003. - 464 p.
2. Medical microbiology. / Ch. Ed. IN AND. Pokrovskt, OK Pozdeev - Moscow: GEOTAR MEDICINE, 1998. - стр. 631-656
3. Borisov L.B. Medical microbiology, virology, immunology .- M .: MIA, 2001.- 734 p.
4. Intrahospital infections // Ed. R.P. Wentzella - M.: Medicine, 1990.- 656 p.
5. Mayanskii A.N. Microbiology for doctors. - Nizhny Novgorod: Publishing house of the Nizhny Novgorod State Medical Academy, 1999. - 400 p.
6. Topical issues of epidemiology and infectious diseases. N. Semina. - M .: Medicine, 1999
7. Intrahospital infection. / Sheretz, Hampton, Ristucina. - Ed. R. P. Wenzela. - M .: Medicine 1990.
8. Intrahospital infection. / co-authors. - educational-methodical manual, Irkutsk, 1999. - 32 p.
9. Medical Microbiology / Ed. Acad. RAMS V.I. Pokrovsky. - Moscow: GEOTAR-MED, 2001
Additional:
1. Borisov LB, Kozmin-Sokolov BV, Freidlin IS A guide to laboratory studies in medical microbiology, virology, immunology. - M .: Medicine, 1993.
2. Medical microbiology / Ch. Ed. IN AND. Pokrovsky, O.K. Pozdeev. - Moscow: GEOTAR MEDICINE, 1998, 2001, 2006. - 1200 p.
3. The determinant of bacteria Berdzhi / Ed. D. Houlta, N. Krig, P. Snitai et al., Moscow: Mir, 1997. - In 2 volumes.
4. Epidemiology of nosocomial infections. / R. Kh. Yafaev, L. P. Zueva. - Leningrad: Medicine, 1989
5. Tets VV A Guide to Practical Studies in Medical Microbiology, Virology and Immunology - M.: Medicine, 2002. - 352 p
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