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Lecture notes, cheat sheets
Infectious diseases. Chicken pox. Herpetic infection. Etiology, epidemiology, pathogenesis, clinical picture, treatment (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 5. Chicken pox. herpetic infection. Etiology, epidemiology, pathogenesis, clinic, treatment 1. Chickenpox Chickenpox is a highly contagious acute viral disease with airborne transmission that occurs mainly in childhood and is characterized by moderate intoxication, fever, vesicular rash on the skin and mucous membranes. Etiology. The causative agent of chickenpox belongs to the herpes group of viruses, contains DNA, has a spherical shape and a diameter of 150-200 nm, is unstable in the external environment. Quickly dies under the influence of high temperatures, ultraviolet radiation, ether. Tolerates freezing well. The virus is volatile and can be transported over considerable distances with air flow. Epidemiology. The virus causes two clinical variants: chickenpox, herpes zoster. It is believed that chicken pox is a manifestation of a primary infection in a susceptible organism (more often in children), since herpes zoster is a reactivation of an infection in an immune and weakened organism. Ways of transmission of infection - airborne, less often - contact-household and vertical. The source of infection is a person with chickenpox or herpes zoster. The patient is contagious in the last 1-2 days of the incubation period and up to 5 days from the appearance of the last vesicles. The virus is found in large quantities in the contents of the vesicles and is absent in the crusts. After the illness, a strong immunity is developed. After an infection, neutralizing antibodies are produced that do not prevent the development of a latent infection. The virus persists for a long time in the cells of the spinal ganglia, the ganglia of the facial and trigeminal nerves, which is explained by the tropism of the virus to the nervous tissue. Against the background of immunodeficiency conditions, reactivation of the infection in the form of herpes zoster is possible. Pathogenesis. The pathogen enters the body by airborne droplets through the mucous membranes of the upper respiratory tract. After the end of the incubation period, viremia sets in. Fixation of the virus occurs in the epithelium of the skin and cells of the mucous membranes, resulting in a characteristic rash. The persistence of the virus in the body can occur and under the influence of any provoking factors - its activation. This can be expressed in the form of local rashes on the skin - herpes zoster or shingles. Clinic. The incubation period can last 11-21 days, with an average of about 14 days. The disease begins acutely: body temperature rises, symptoms of intoxication appear, appetite decreases. At the same time, a rash appears on the whole body with elements in the form of small papules, which quickly turn into vesicles. After 1-3 days, the vesicles dry up, and crusts form in their place, which fall off on the 2-3rd week of the disease. After them, light pigmentation remains on the skin. Scars do not form. Itching of the skin is observed in young children and persons prone to allergic reactions. New elements pour out due to their non-simultaneous maturation; the rash is characterized by polymorphism. Elements of chickenpox rash appear immediately on all skin, including the scalp, as well as on the oral mucosa, conjunctiva. The skin of the palms and feet is not covered with a rash. The elements do not merge. The background of the skin is unchanged. Weakened children are faced with a very rare form - a generalized chickenpox infection with damage to the visceral organs, which can be fatal. The consequence of this form may be treatment with corticosteroids and cytotoxic drugs. Classification: typical and atypical forms. Atypical include rudimentary, generalized, hemorrhagic, pustular, gangrenous forms. Complications develop rarely and are associated with the addition of a secondary bacterial infection (abscesses, cellulitis, pneumonia, encephalitis, otitis media, sinusitis, conjunctivitis, erysipelas, scarlet fever, lymphadenitis, stomatitis). The diagnosis is established on the basis of anamnesis, complaints, clinical and laboratory data. In the blood test - leukopenia, lymphocytosis, ESR is normal. If necessary, laboratory methods such as electron microscopy of silver-stained smears of the contents of vesicles, viroscopy, ELISA, RSK, neutralization reaction can be used. The differential diagnosis is carried out with streptoderma, a generalized form of herpes simplex, insect bites. Treatment. Treatment is carried out on an outpatient basis, in severe cases with complications from the central nervous system and purulent complications, or according to epidemiological indications, patients are hospitalized in a hospital. Bed rest in the first 2-3 days of illness, vitamin therapy, drinking plenty of water, diet according to age. Hygienic maintenance of the patient with the prevention of secondary infection. Vesicles are lubricated with 1-2% potassium permanganate solution, 1% brilliant green solution, oral mucosa is treated with an aqueous solution of aniline dyes and other disinfectants. Antiviral etiotropic therapy is carried out with acyclovir. In severe cases, the appointment of specific varicellose-zoster immunoglobulin / m. Interferon inducer preparations - cycloferon, neovir - are used for severe immunodeficiency. The prognosis is favorable. Prevention. The patient is subject to isolation at home until the 5th day from the moment the last element of the rash appears. Disinfection is not performed. Children under 3 years of age who have been in contact with a patient with chickenpox and who have not had it before are separated from the 11th to the 21st day, counting from the moment of contact. 2. Herpetic infection Herpes infection - diseases caused by the herpes simplex virus, characterized by damage to the skin and mucous membranes, in some cases can cause damage to the eyes, nervous system and internal organs. Etiology. The causative agent belongs to the herpes family, is divided into six antigenic groups. Type I is the most common, with the type II virus associated with the occurrence of genital herpes and generalized infection of newborns. Pathogenesis. The gates of infection are the skin and mucous membranes. Invading, the herpes virus remains in the human body for life as a latent infection, which has the ability to turn into clinically pronounced forms under the influence of factors that weaken the body (flu and other diseases, treatment with immunosuppressants, AIDS, etc.). Clinic. The incubation period is 2-12 days (usually 4 days). Primary infection usually proceeds subclinically, only 10-20% of patients develop various clinical manifestations. The following clinical forms are distinguished: 1) herpetic skin lesions (localized and widespread); 2) herpetic lesions of the oral cavity; 3) ORZ; 4) genital herpes; 5) herpetic lesions of the eyes (superficial and deep); 6) encephalitis and meningoencephalitis; 7) visceral forms (hepatitis, pneumonia); 8) generalized herpes of newborns. Localized herpetic skin lesions are the most common, they usually accompany some other disease (ARI, malaria, meningococcal infection, etc.). General symptoms are absent or masked by manifestations of the underlying disease. Bubbles are localized around the mouth, on the lips, wings of the nose. In some cases, there is a common herpetic rash. The defeat of the mucous membranes of the oral cavity usually proceeds in the form of aphthous herpetic stomatitis. Herpes viruses cause 5-7% of all acute respiratory infections; clinically, they differ little from acute respiratory infections of other etiologies. Sexually transmitted genital herpes occurs more often in the form of necrotic cervicitis, herpetic lesions of the vagina and external genitalia. With this form, cervical cancer can occur, in pregnant women it is dangerous for the fetus (severe generalized herpes of the newborn may occur). Herpetic eye damage often occurs in the form of superficial and deep lesions of the cornea. The disease can have a long relapsing course. May cause persistent clouding of the cornea. Herpetic encephalitis is severe and often ends in death. Visceral forms of herpes usually develop as a result of massive treatment with various immunosuppressants, and also in patients with AIDS, they often manifest as hepatitis, pneumonia, encephalitis. Generalized herpes of newborns occurs simultaneously with encephalitis, lesions of the skin and internal organs, without treatment with antiviral drugs, it usually ends in death. Diagnosis of a herpes infection is facilitated by the presence of characteristic lesions of the skin or mucous membranes. Confirmation of the diagnosis is facilitated by the use of virus isolation from various materials (contents of vesicles, scrapings from the cornea, cerebrospinal fluid, cervical biopsy material, etc.). Treatment. With localized and uncomplicated forms of herpes, the underlying disease is treated. The elements of the rash are topically treated with a 1% solution of methylene blue or brilliant green. The crusts are lubricated with erythromycin or tetracycline ointment. To prevent the spread of the infectious process, intramuscular injection of 6 ml of normal human immunoglobulin is used. If the elements of the rash suppurate, it is necessary to use antibiotic therapy: oxacillin (3 times a day, 1 g), erythromycin (4 times a day, 0,5 g). To prevent suppuration of the eyes, it is recommended to use a 0,1% solution of 5-iodine-2-deoxyuridine (kerecid). It also has a beneficial effect in herpetic lesions of the mucous membranes. The prognosis for herpes encephalitis and generalized herpes infection is doubtful. Eye damage is promoted by a long relapsing course, which leads to disability. Prevention. To prevent the generalization of infection, normal human immunoglobulin is administered (6 ml every 3 weeks). Relapses can be prevented with an effective killed herpes virus vaccine. There are no activities in the outbreak. Author: Gavrilova N.V. << Back: Measles. Rubella. Etiology, pathogenesis, clinical picture, diagnosis, treatment (Measles. Rubella) >> Forward: Parotitis. Etiology, epidemiology, pathogenesis, clinic, treatment
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