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Intestinal anthroponotic infections and their prevention

Acute intestinal infections include typhoid, paratyphoid A and B, dysentery, cholera, salmonellosis, infectious hepatitis A, etc. These intestinal infections are characterized by the same localization of the pathogen (intestines), the same infection mechanism (fecal-oral), a similar clinical picture of the disease (gastrointestinal upset) and the same principles for their prevention. Sources of infection are a sick person and a carrier, with the exception of paratyphoid B and salmonellosis, the source of which, in addition to humans, may be some animals (cattle, pigs, birds).

A special role in the spread of intestinal infections belongs to the food and water transmission factors, which is associated with the long-term survival of pathogens in them. As a rule, food products are infected through the dirty hands of sick people or bacteria carriers, as well as through contaminated water, which is used for drinking purposes, washing, the process, etc. Food products can also be infected by the transmission of intestinal infections by insects and rodents. Of particular danger in the transmission of infection is infected food products that are not subjected to heat treatment before use (vinaigrettes, salads, vegetables, fruits, etc.) or are infected after heat treatment (milk, dairy products, minced products, jelly, etc.).

Typhoid fever and paratyphoid A and B are acute intestinal infections, similar in mechanism (pathogenesis) of the disease and clinical manifestations. They relate to anthroponosis, can be in the form of individual cases, as well as in the form of water and food epidemics.

Etiology. Pathogens belong to the family of intestinal bacteria of the Salmonella genus: typhoid fever causes Salmonella typhi, paratyphoid A and B - Salmonella paratyphi A and B. According to morphology, these are sticks, gram-negative (d-), motile, spores and capsules do not form, facultative anaerobes, optimal development temperature - 37 ° C.

The source is a sick person or carrier. Pathogens are excreted from the body into the external environment along with bowel movements and urine. These infections are characterized by the fecal-oral infection mechanism, which is realized by water, food and contact-household route.

Sustainability. In the external environment, typhoid paratyphoid bacteria can persist from several days to several months. So, in running water they survive for 5-10 days, in stagnant water - about a month, in ice and in the silt of water bodies - for several months. They withstand low temperatures and drying well. When heated to 50 ° C, they die within 60 minutes, up to 60 ° C - 30 minutes, up to 80 ° C - 10-15 minutes, at 100 ° C they die instantly.

In food products, depending on their type and storage conditions, the causative agents of typhoid and paratyphoid can remain viable for several days, months and even years. Food contamination is extremely dangerous since individual products are a favorable nutrient medium for pathogens, where they can not only be stored for a long time, but also multiply (milk, sour cream, cottage cheese, minced meat, jelly, etc.).

Typhoparathyphoid diseases are characterized by seasonality: the largest number of cases is recorded in the summer-autumn period. This is explained by the fact that during this period the conditions for the survival and reproduction of bacteria in the external environment, including in food products, are most favorable.

Pathogens enter the body through the mouth, overcome the protective barriers of the upper digestive tract and penetrate through the small intestine into the lymphatic system, blood, liver and spleen. Part of the pathogen is destroyed with the release of endotoxin, which affects the nervous system, and part multiplies in the body.

The incubation period for typhoid fever can last from 7 to 28 days, and for paratyphoid fever from 2 days to 2 weeks. The selection of pathogens from the patient's body begins at the end of the incubation period and at the height of the disease.

Clinic. The disease begins gradually: fatigue, malaise, headache appear, the temperature gradually rises to 39-40 ° C. There may be a rash, loose stools at the onset of the disease, inflammation of the small intestine and intestinal bleeding. From the fourth week, the temperature gradually drops and the patient begins to recover. Sometimes the disease proceeds in a milder form (more often with paratyphoid fever).

Approximately 3-5% of patients who remain ill remain carriers of pathogens for a long time, and some remain lifelong (chronic bacterial carriers). They are the main sources of infection. After the disease, stable immunity is developed.

Dysentery is an intestinal anthroponotic infection.

Etiology. The causative agents of dysentery belong to the family of intestinal bacteria of the genus Shigella. The most common shigella are Zone and Flexner.

Dysenteric sticks (Shigella) g-, motionless, do not form spores and capsules, facultative anaerobes. The optimum development temperature is 37 ° C (Sonne sticks can develop at a temperature of 40-45 ° C).

The source of pathogens is a sick person and bacteria carriers. Patients in acute form are especially dangerous, because they secrete a huge amount of pathogens through the intestines.

Dysentery is characterized by a fecal-oral infection mechanism, which is realized by water, food and contact-household means. The transmission factors are food, water, hands, surrounding objects, soil, flies. The main transmission route for Shigella Zone is food, Flexner is water and contact-household. The disease is seasonal in nature - most often recorded in July-September. The leading age group is children under 6 years old.

The stability of dysenteric sticks in the external environment varies from several days to several months and depends on the temperature of the medium, humidity, pH, type of pathogen, etc.

Dysenteric sticks remain viable in river water for 6-35 days, in tap water - up to 92 days and can reproduce in food products (milk, sour cream, etc.).

The causative agent of Sonne dysentery is less pathogenic and therefore mainly causes mild and atypical forms of the disease, which often remain obscure and pose a danger to others. Especially dangerous are such patients or bacteria carriers working in catering establishments.

The incubation period for dysentery is from 1 to 7 days.

The clinical picture. In most cases, the disease begins in an acute form - chills, fever, fever up to 38-40 ° C. However, sometimes the temperature rises slightly or does not rise at all. There are abdominal pains, loose stools with an admixture of mucus and blood (in severe cases, stool frequency - 20-30 times a day). On the part of the nervous system, intoxication syndrome is observed, on the part of the cardiovascular system, an unstable pulse, a decrease in blood pressure, etc.

In mild forms, the disease lasts from 3 to 8 days, in severe forms - up to several weeks.
Dysentery can occur not only in acute form, but also in chronic form - with relapses of the disease and bacterial carriage. After the disease, specific immunity is formed within one year.

In the prevention of dysentery, sanitary-hygienic measures at food facilities and sanitary-educational work are of great importance. Recovering for a long time can be bacteriocarriers (up to 6 months), therefore, they are under medical supervision.

Patients with dysentery and bacteriocarriers are not allowed to work in food enterprises, catering and trade.

Cholera is an acute, especially dangerous intestinal infection. It spreads very quickly, there may be an epidemic of cholera. The endemic focus of cholera is India (the Ganges and Brahmaputra rivers). The disease is most often registered in countries with a warm climate in the summer-autumn period.

Etiology. The causative agents of cholera are the classic cholera vibrio and El Tor vibrio. They have the form of slightly curved sticks, g-, spores and capsules do not form, are mobile (flagella are located polar), obligate aerobes. The optimum development temperature is 25-38 ° C. They produce exotoxin, a cholerogen that causes the dehydration and demineralization of the human body.

Currently, the cholera caused by the pathogen El Tor has become pandemic. It has a more benign course, a greater number of vibriocarriers, the rapid spread of the disease across all continents, and a significant length of the period of increased incidence.

The source of infection is only a person, a patient, or a carrier of cholera vibrios, who came from a region that is not well for cholera.

Cholera is characterized by the fecal-oral infection mechanism, which is realized by water, food and contact-household means. The leading route of waterborne infection is the use of infected water for drinking, washing vegetables, fruits, etc. Food-borne transmission is most often associated with the use of milk, boiled rice, shrimp, crab, shellfish, not subjected to sufficient heat treatment.

Sustainability. Cholera vibrios are very sensitive to heat, drying, acids, and disinfectants. When heated to 60 ° C, they die after 30 minutes, and when boiled, after 1 minute. Able to survive in the environment for a long time, long stored at low temperatures. They maintain vital activity in the soil from 8 to 90 days, in running water - 3-5 days, in reservoirs - 7-13 days, in sea water - from 10 to 60 days. In food products, depending on the type of product and storage conditions, cholera vibrio can remain viable from 2-5 days to a month.

The incubation period is from several hours to 5 days.

The clinical picture. The disease usually begins acutely: there are sharp pains in the abdomen, repeated, profuse, indomitable vomiting, frequent loose stools (10-20 or more times a day). Body temperature drops below normal. Loss of fluid in the first day of the disease can reach 10-15 liters or more. Dehydration (dehydration) and demineralization of the body develops, which lead to thickening of the blood, impaired water-electrolyte metabolism, decreased cardiac activity, seizures, cyanosis (blue and pale lips, limbs). In severe cases, a "cholera coma" develops, accompanied by loss of consciousness and death. Sometimes there are fulminant forms of "dry cholera" with an upcoming adverse outcome after 4-5 hours.

The transferred disease does not form a stable immunity.

Viral hepatitis A (infectious, epidemic, Botkin's disease). Typical intestinal viral infection with fecal-oral transmission mechanism.

Etiology. Hepatitis A virus was isolated in 1973 and belongs to the genus Enterovirus of the Picornaviridae family (pico is small, rna is RNA containing the virus). Most picornaviruses are transmitted through oral infection.

The hepatitis A virus tolerates drying and low temperatures well, it can persist for a long time in water (3-10 months), in the soil and on surrounding objects (about 1 month). It is inactivated at a temperature of 100 ° C for 5 minutes. The virus is UV-sensitive and relatively resistant to chlorine.

Hepatitis A is transmitted primarily through water and food. Food contamination with viruses is possible during processing, preparation, storage and sale. Infection occurs through food contaminated with feces, water, hands, equipment, implements, household items. Susceptibility to hepatitis A is universal, but more often the disease is recorded in children older than 1 year (especially 3-12 years old) and in young people 15-29 years old. A maximum of diseases occurs in the autumn-winter period. There may be single outbreaks and major epidemics of hepatitis A. More often they are associated with water. Possible transmission of hepatitis A with donated plasma and sexually transmitted infections (5-7% of gay men are infected with it each year).

Viral hepatitis A is ubiquitous. The sanitary culture of the population and the sanitary condition of housing, public catering establishments, child care facilities, military contingents, etc., have a decisive influence on its distribution. In countries with a high standard of living, the incidence of hepatitis A is lower than in developing countries.

Pathogenesis. After infection, the hepatitis A virus from the intestine enters the bloodstream, and then into the liver. As a result of the introduction and replication of the virus in the liver cells, inflammatory and necrotic processes develop, accompanied by the breakdown of liver cells and the phenomena of liver failure. Malignant forms of hepatitis A account for about 0.5%.

The incubation period lasts from 6 to 50 days.

The clinic of hepatitis A can be in the icteric and anicteric form, as well as without clinical manifestations. The mixed form is more common, which is characterized by an acute onset with fever up to 38-40 ° C, cough, runny nose, headache, decreased appetite, a feeling of bitterness in the mouth, abdominal pain, sometimes vomiting, pain in muscles and joints, urine becomes color beer or tea, bowel movements become discolored, the skin and sclera of the eyes turn yellow, the liver increases.

Hepatitis A has a benign course - 90% of patients recover, but in 5-10% of patients the disease lasts several months. Complications of the disease are possible, there are no chronic forms of the disease. Persons who have had hepatitis A develop persistent lifelong immunity and are immune to reinfection.

Prevention consists of a set of sanitary and hygienic measures common to all intestinal infections, improving sanitary conditions, vaccinating the population and people at high risk (food workers, utilities, sailors, tourists, military teams, etc.).
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Intestinal anthroponotic infections and their prevention

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