INTESTINAL INFECTIONSINTESTINAL INFECTIONS

Assoc. Prof. Dr. Doycheva, MDAssoc. Prof. Dr. Doycheva, MD

General Characterist icsGeneral Characterist ics

The key role of intestinal infection in The key role of intestinal infection in human health and socioeconomic system human health and socioeconomic system is determined by the epidemic patterns of is determined by the epidemic patterns of occurrence and the high morbidity rate, occurrence and the high morbidity rate,

specif ic for some of them, such as specif ic for some of them, such as Shigellosis, Salmonellosis and Viral Shigellosis, Salmonellosis and Viral

hepatit is A. The infant mortali ty rate is hepatit is A. The infant mortali ty rate is highly affected by nosocomial infections, highly affected by nosocomial infections,

such as E.coli enterit is and such as E.coli enterit is and Salmonellosis, with increased lethality Salmonellosis, with increased lethality

among infantamong infant ..

Characteristic features of the Characteristic features of the epidemic process of intestinal epidemic process of intestinal

infectionsinfectionsIntestinal infections are characterized by Intestinal infections are characterized by

great etiologic variety. They are caused great etiologic variety. They are caused by intestinal bacteria of the by intestinal bacteria of the

Enterobacteriaceae family /genera Enterobacteriaceae family /genera Esherichia, Shigella and Salmonella/, Esherichia, Shigella and Salmonella/,

genera Vibrio, Leptospira, by genera Vibrio, Leptospira, by condit ionally pathogenic bacteria of the condit ionally pathogenic bacteria of the

genera Proteus, Enterobacter, Klebsiella, genera Proteus, Enterobacter, Klebsiella, Staphylococcus, Brucella, Pseudomonas Staphylococcus, Brucella, Pseudomonas

aeroginosa, Clostridium and viruses.aeroginosa, Clostridium and viruses.

These infections have fecal-oral These infections have fecal-oral transmission mechanism, realized transmission mechanism, realized via multiple routes of spread and via multiple routes of spread and

resulting in the occurrence of water, resulting in the occurrence of water, food, contact and nosocomial food, contact and nosocomial

epidemics and epidemic outbreaks.epidemics and epidemic outbreaks.

Water epidemicsWater epidemics

They are caused by three main They are caused by three main factors:factors:

- Contamination of drinking water Contamination of drinking water resourcesresources

- Technical failures and breakdown of Technical failures and breakdown of water supply and sanitation water supply and sanitation installations and distribution installations and distribution systemssystems

- Use of drinking water, non-meeting Use of drinking water, non-meeting the requirement of the State the requirement of the State StandartsStandarts

Food epidemicsFood epidemics

They refer to primary /during animal,s They refer to primary /during animal,s l i fetime/ and secondary l ifetime/ and secondary

contamination of food products of contamination of food products of animal origin and may occur during animal origin and may occur during

the procesing and marketing of the procesing and marketing of these products, as well as in cases these products, as well as in cases

of previous/concomitant of previous/concomitant consumption of contaminated fruits consumption of contaminated fruits

and vegetables.and vegetables.

Contact epidemicsContact epidemics

They refer to habits/conditions of l i fe, They refer to habits/conditions of l i fe, associated with poor hygiene, such associated with poor hygiene, such

as contaminated hands, as contaminated hands, insects/fl ies, toys. Additionally, insects/fl ies, toys. Additionally,

classical intestinal infections occur classical intestinal infections occur as nosocomial infections.as nosocomial infections.

The involvment and subsequent The involvment and subsequent secretory and absorptive secretory and absorptive

dysfunction and disturbed motil i ty dysfunction and disturbed motil i ty of the upper gastrointnstinal tract of the upper gastrointnstinal tract are shared characterist ics in the are shared characterist ics in the

pathogenesis of bacterial pathogenesis of bacterial intenstinal infections. intenstinal infections.

Patients age and related individually Patients age and related individually specif ic immunogenesis are the specif ic immunogenesis are the

predisposing factors for a more severe predisposing factors for a more severe clinical course of the intestinal cl inical course of the intestinal

infections. In addit ion, specif ic nutrient infections. In addit ion, specif ic nutrient intake pattern, the type, resistance-intake pattern, the type, resistance-

marker, toxigenicity, pathogenicity and marker, toxigenicity, pathogenicity and degree of invasion of the causative agent degree of invasion of the causative agent

play an important role in disease play an important role in disease progression.progression.

There is general susceptibil i ty to intestinal There is general susceptibil i ty to intestinal infections causative agents. Postnatal infections causative agents. Postnatal immunity increases with the age, while immunity increases with the age, while

the immunity, acquired after the i l lness is the immunity, acquired after the i l lness is stable and continuous for only some of stable and continuous for only some of

the intenstinal infections, such as the intenstinal infections, such as Abdominal typhus, Salmonellosis, E.coli Abdominal typhus, Salmonellosis, E.coli enterit is and Poliomyelit is. The acquired enterit is and Poliomyelit is. The acquired

immunity is also type-specif ic, thus, immunity is also type-specif ic, thus, making the specif ic immunoprophylaxis a making the specif ic immunoprophylaxis a

valuable tool in the prevention of valuable tool in the prevention of intestinal infections.intestinal infections.

Prophylaxis/Prevention of the Prophylaxis/Prevention of the intestinal infectionsintestinal infections

Hygienic activit ies andmeasures Hygienic activit ies andmeasures aiming at discontinuation of aiming at discontinuation of infection transmission are the major infection transmission are the major strategy in prophylaxis of intestinal strategy in prophylaxis of intestinal infections.infections.

Anti-epidemic activit ies and Anti-epidemic activit ies and measuresmeasures

They include:They include:- Immediate epidemiologic research - Immediate epidemiologic research

in the focus of infection diseasein the focus of infection disease

- Measures against the source of Measures against the source of infection and the contactsinfection and the contacts

- Extensive prophylaxis in the focus Extensive prophylaxis in the focus of infectious diseaseof infectious disease

- Focal disinfection, disinsection and Focal disinfection, disinsection and derattization derattization

Basic principles in the fight Basic principles in the fight against infectious diseasesagainst infectious diseases

Prophylactic and anti-epidemic Prophylactic and anti-epidemic measuresmeasures

Structure of the epidemic Structure of the epidemic process:process:

- Source of infectionSource of infection- Mechanism of transmissionMechanism of transmission- Susceptibi l i ty of the populationSusceptibi l i ty of the population

Changes in these factors caused by Changes in these factors caused by the social and natural environment the social and natural environment

reflect on the intensity of the reflect on the intensity of the epidemic process. Thus the epidemic process. Thus the

efficacious prophylactics and efficacious prophylactics and effective fight against inf. diseases effective fight against inf. diseases

are possible only when the are possible only when the antiepidemic measures are directed antiepidemic measures are directed

in three ways: in three ways:

- Measures eliminating or Measures eliminating or decontaminating the source of decontaminating the source of infectioninfection

- Measures stopping the Measures stopping the mechanism of transmissionmechanism of transmission

- Measures stimulating Measures stimulating insusceptibi l i ty of the insusceptibi l i ty of the population to a certain diseasespopulation to a certain diseases

Measures eliminating or Measures eliminating or decontaminating the source of decontaminating the source of

infectioninfection

- - Measures for extermination- Measures for extermination- elimination of the sick elimination of the sick animals( carriers of infection). animals( carriers of infection). The method is the best one in The method is the best one in case of infected wild animals as case of infected wild animals as well as domestic animals.well as domestic animals.

-- Measures for deratt ization – used at Measures for deratt ization – used at rodents, reservoirs of infectionsrodents, reservoirs of infections

- Sanitary measures- concerning - Sanitary measures- concerning domestic and farm animals( for domestic and farm animals( for example, carriers of Brucellosis). In example, carriers of Brucellosis). In this way animals are used for the this way animals are used for the purposes of the farms purposes of the farms simultaneously whit the measures simultaneously whit the measures for their recovery.for their recovery.

Measures for extermination are not Measures for extermination are not applicable at anthroponosis inf. diseases applicable at anthroponosis inf. diseases

where the source of infection is the man- a where the source of infection is the man- a sick person or a carriersick person or a carrier

It this case the aim is to It this case the aim is to decontaminate the source of decontaminate the source of

infection putting it in such infection putting it in such conditions in which the conditions in which the

possibil i t ies for transmission of possibil i t ies for transmission of infection care cut off.infection care cut off.

Isolation of the sick persons- in Isolation of the sick persons- in an infectious ward or at home. an infectious ward or at home.

Complete influencing of the Complete influencing of the source of infection is impeded source of infection is impeded also by the characteristics of also by the characteristics of

the clinical course of the the clinical course of the disease- inapparent, mild or disease- inapparent, mild or

chronic forms.chronic forms.

Localization and decontamination of Localization and decontamination of the source of infection depend on:the source of infection depend on:

- Living conditions- condit ions Living conditions- condit ions facil i tating transmission of infection facil i tating transmission of infection to other person should be to other person should be eliminatedeliminated

- Attitudes of the population- whet Attitudes of the population- whet her people seek doctors help her people seek doctors help immediately, refusal of immediately, refusal of hospitalization, as well as degree of hospitalization, as well as degree of health knowledge and responsibil i ty health knowledge and responsibil i ty for the economic costsfor the economic costs

-- Possibi l i t ies for specif ic, Possibi l i t ies for specif ic, etiologic treatment of the sick etiologic treatment of the sick persons and carriers of persons and carriers of infectioninfection

Urgent prevention is also one of the Urgent prevention is also one of the measures for influencing the source measures for influencing the source

of infection. It is the use of of infection. It is the use of prophylactic and creative means to prophylactic and creative means to prevent development of the disease prevent development of the disease

from the carriers of infection in from the carriers of infection in incubation. For this purpose incubation. For this purpose immune serums, vaccines, immune serums, vaccines,

bioproducts, etc.bioproducts, etc.

Measures stopping the mechanism of Measures stopping the mechanism of transmission of infectiontransmission of infection

This measures are various ones. This measures are various ones. They are mainly related to the They are mainly related to the specif ic characteristics of the specif ic characteristics of the mechanism of transmission of mechanism of transmission of

the different inf. Diseases. the different inf. Diseases. Generally, i t is very diff icult to Generally, i t is very diff icult to

carryout such measures.carryout such measures.

Diseases belonging to the group of Diseases belonging to the group of enteric infectionsenteric infections

The measures require the agents The measures require the agents of infection in the faeces of the of infection in the faeces of the sick persons not to get trough sick persons not to get trough

food, water into the food, water into the gastrointenstinal tract of the gastrointenstinal tract of the

healthy people.healthy people.

Sanitary measures eliminating the Sanitary measures eliminating the faecal-oral mechanism of infection faecal-oral mechanism of infection are of crucial importance:are of crucial importance:

- Development and urbanization of Development and urbanization of the built-up areasthe built-up areas

- Wares upply, sewerageWares upply, sewerage- Decontamination of the sewerage Decontamination of the sewerage

waterswaters

- Collection and decontamination Collection and decontamination of the hard wastesof the hard wastes

- Sanitary measures in public Sanitary measures in public cateringcatering

- Following the regulations of Following the regulations of sanitationsanitation

- School hygieneSchool hygiene

Diseases belonging of the group of Diseases belonging of the group of respiratory infectionsrespiratory infections

Gauze masks, aeration and Gauze masks, aeration and venti lation, bactericidial lamps, venti lation, bactericidial lamps,

disinfection disinfection

Diseases belonging to the group of Diseases belonging to the group of blood infectionsblood infections

Character, access and effectiveness Character, access and effectiveness of the measures applied depend on of the measures applied depend on the biological carriers:the biological carriers:

- Agromeliorative measuresAgromeliorative measures- Hydrotechnical measuresHydrotechnical measures- Means of individual preventionMeans of individual prevention- Stimulating accumulation of health Stimulating accumulation of health

knowledgeknowledge

Diseases belonging to the group of Diseases belonging to the group of covering infectionscovering infections

They are transmitted through the They are transmitted through the personal belongings, household, personal belongings, household, goods, etc.:goods, etc.:

- DisinfectionDisinfection- Hygienic measures for Hygienic measures for

decontaminationdecontamination- Stimulating the accumulation of Stimulating the accumulation of

health knowledge of the populationhealth knowledge of the population

Measures stimulating insusceptibil i ty Measures stimulating insusceptibil i ty of the populationof the population

A perspective for prevention and A perspective for prevention and fight against inf. diseases is f ight against inf. diseases is

development of specif ic development of specif ic insusceptibi l i ty of the insusceptibi l i ty of the

population to inf. diseases.population to inf. diseases.

Immune system recognized the Immune system recognized the relevant antigens through its relevant antigens through its immunocompetent cells and immunocompetent cells and

reacts against them producing reacts against them producing immune response as well as immune response as well as

developing immune memory and developing immune memory and immune tolerabil i ty.immune tolerabil i ty.

Immune response- is a complex Immune response- is a complex reaction of the organism reaction of the organism induced by the antigen induced by the antigen penetrated in it, which penetrated in it, which

morphologic base is morphologic base is proli feration and differentiation proli feration and differentiation of the immunocompetent cells.of the immunocompetent cells.

Recognition of the antigens is Recognition of the antigens is made with the help of two types made with the help of two types

of lymphocytes:of lymphocytes:- T-lymphocytes- they help - T-lymphocytes- they help developed their immunologic developed their immunologic competence through thymus competence through thymus

and that is are called “thymus-and that is are called “thymus-dependent”dependent”

-- B- lymphocytes- they have B- lymphocytes- they have developed their immunologic developed their immunologic

competence through the competence through the “Fabricius bursa” (for the birds) “Fabricius bursa” (for the birds) or through its equivalent for the or through its equivalent for the

mammals, probably bone mammals, probably bone marrow or part of the lymph marrow or part of the lymph

tissue of the intenstines- t issue of the intenstines- Payer,s plaques, appendix and Payer,s plaques, appendix and

tonsilstonsils

In the course of the evolution the In the course of the evolution the following types of immunity have following types of immunity have

been developed:been developed:- Species immunity- it is formed - Species immunity- it is formed

during the phylogenetic during the phylogenetic development of the individual. It development of the individual. It

represents a state of represents a state of insusceptibil i ty of the organism insusceptibil i ty of the organism

related to the species to which the related to the species to which the man or the animal belong.man or the animal belong.

- Individual immunity- it is formed Individual immunity- it is formed durring the ontogenetic durring the ontogenetic

development of the individual. The development of the individual. The abil ity of the organism to develop abil ity of the organism to develop ontogenetic mechanism is a result ontogenetic mechanism is a result from its phylogenesis. Individually from its phylogenesis. Individually

immunity is divided as follows:immunity is divided as follows:- Naturally immunity, which on its Naturally immunity, which on its

part, is divided to:part, is divided to:

Passive- due to antibodies, inherited Passive- due to antibodies, inherited from the motherfrom the mother

Active- post infectious, domestic Active- post infectious, domestic immunityimmunity

- Non-naturally immunity (post Non-naturally immunity (post immunization), divided to:immunization), divided to:

Active- developed after application of Active- developed after application of vaccines and toxoidesvaccines and toxoides

Passive- after administration of ready Passive- after administration of ready made antibodies trough serums and made antibodies trough serums and immunoglobulinesimmunoglobulines

The difference between these The difference between these two types of development of two types of development of

immunity is related to the way immunity is related to the way of development as well as the of development as well as the

level of i ts intensity and level of i ts intensity and duration.duration.

According to the mechanism of According to the mechanism of development of the immune development of the immune

response immunity is divided as response immunity is divided as follows:follows:

> Humoral immunity- it acts trough B-> Humoral immunity- it acts trough B-lymphocytes as well as antibodies lymphocytes as well as antibodies

circulating freely as circulating freely as immunoglobulins in the blood and immunoglobulins in the blood and

the other body l iquids. the other body l iquids.

The antibodies react directly to the The antibodies react directly to the antigens forming a type of response” antigens forming a type of response”

antigen-antibody”- precipitation, antigen-antibody”- precipitation, accumulation, neutralization, etc. accumulation, neutralization, etc.

depending on its condit ions.depending on its condit ions.> Cell immunity- it acts trough the > Cell immunity- it acts trough the

circulating T-lymphocytes together with circulating T-lymphocytes together with the non-immunoglobulin mediators of the the non-immunoglobulin mediators of the lymph function ( activated macrophages)lymph function ( activated macrophages)

Local immunity is an antigen Local immunity is an antigen (mainly IgA) and is cell (mainly IgA) and is cell

mediated- in the mediated- in the immunosecretory system of the immunosecretory system of the mucous of the gastrointestinal mucous of the gastrointestinal tract and respiratory ways (the tract and respiratory ways (the

entrance of infection).entrance of infection).

Collective immunity- it is the abil i ty of Collective immunity- it is the abil i ty of the human collective to resist to the the human collective to resist to the

activity of the agents of the inf. activity of the agents of the inf. diseases and to prevalence of the diseases and to prevalence of the epidemic process. It is determined epidemic process. It is determined by the specific immune structure of by the specific immune structure of

the population as well as the the population as well as the possibil i ty for realization of the possibil i ty for realization of the

mechanism of transmission in the mechanism of transmission in the real circumstances.real circumstances.

Non-specific immunologic Non-specific immunologic structure – it characterized the structure – it characterized the degree of insusceptibi l i ty of the degree of insusceptibi l i ty of the population to all inf. diseases. population to all inf. diseases.

It is measured by different It is measured by different immunologic, physiologic and immunologic, physiologic and

other methods.other methods.

They are many different contingents of They are many different contingents of susceptible individuals:susceptible individuals:

Newborn and toddles (due to Newborn and toddles (due to indeveloped immune system)indeveloped immune system)

Individuals immigrating to regions which Individuals immigrating to regions which are endemic for certain diseasesare endemic for certain diseases

Individuals suffering from innate and Individuals suffering from innate and acquired impairments of the immune acquired impairments of the immune system of immunogenesissystem of immunogenesis

Characteristics of the three directions of Characteristics of the three directions of prevention and fight against inf. diseases prevention and fight against inf. diseases provide the possibil i ty for achieving the provide the possibil i ty for achieving the necessary practical results at many inf. necessary practical results at many inf.

diseases if the measures influencing the diseases if the measures influencing the preventive directions are simultaneously preventive directions are simultaneously

carried out- decontamination of the carried out- decontamination of the source of infection, stopping the source of infection, stopping the mechanism of transmission and mechanism of transmission and

stimulating the specific insusceptibil i ty of stimulating the specific insusceptibil i ty of the population. the population.

Anti-epidemic measures in the Anti-epidemic measures in the epidemic centreepidemic centre

Measures to the patient:Measures to the patient:>Early f inding and recognition of the >Early f inding and recognition of the

diseasedisease>Putting proper diagnosis:>Putting proper diagnosis:- Clinical methodsClinical methods- Laboratory methodsLaboratory methods- Epidemiological methodsEpidemiological methods

>Registration and informing for the >Registration and informing for the inf. diseases:inf. diseases:

- Quick informing- form Quick informing- form №№ 58 of 58 of Ministry of healthMinistry of health

- Registration book of inf. diseases- Registration book of inf. diseases- form form №№ 60 of Ministry of health60 of Ministry of health

- Registration book of hospital Registration book of hospital infections- form infections- form №11№11 of Ministry of of Ministry of healthhealth

>Isolation of the patient in an >Isolation of the patient in an infectious ward or at homeinfectious ward or at home

- Transporting of the patient- in a Transporting of the patient- in a suitable way for him/her, safe for suitable way for him/her, safe for the other personsthe other persons

- Sanitary manipulation- bathing, Sanitary manipulation- bathing, decontamination of the clothes and decontamination of the clothes and underwearunderwear

- Specific etiologic therapySpecific etiologic therapy- Dehospitalization of the patients:Dehospitalization of the patients:. After full cl inical recovery. After full cl inical recovery. Elimination of the pathogenic agent. Elimination of the pathogenic agent. Disinfection of the clothes, . Disinfection of the clothes,

underwearunderwearChronically sick patients are under Chronically sick patients are under

dispansary observation.dispansary observation.

Measures to the other persons Measures to the other persons (contacting)(contacting)

Measures to contacting persons:Measures to contacting persons: Epidemiological investigation Epidemiological investigation

for f inding of all contacting for f inding of all contacting personspersons

Registration- in “Book for Registration- in “Book for persons in contact with acutely persons in contact with acutely infected patients”- form infected patients”- form №61№61

Medical observation- a maximal Medical observation- a maximal incubation period, thermometring, incubation period, thermometring, clinical examinationclinical examination

Sanitary manipulation- when Sanitary manipulation- when necessarynecessary

Quarantine of the contacting Quarantine of the contacting persons- highly infected ones in persons- highly infected ones in isolation- serologic, virusological, isolation- serologic, virusological, microbiological analysesmicrobiological analyses

Active or passive immunizationActive or passive immunization Urgent prevention with Urgent prevention with

antibiotics and antibiotics and chemotherapeutical agentschemotherapeutical agents

Measures to the carriers of infection:Measures to the carriers of infection: Finding- epidemiological Finding- epidemiological

investigation, microbiological investigation, microbiological investigationinvestigation

Sanitation – directed to elimination Sanitation – directed to elimination and cleaning of the pathogenic and cleaning of the pathogenic microorganismsmicroorganisms

IsolationIsolation

Specific preventionSpecific prevention

Definit ion: An approach for Definit ion: An approach for development of non-natural development of non-natural

specif ic insusceptibi l i ty to the specif ic insusceptibi l i ty to the etiologic agent of a certain inf. etiologic agent of a certain inf.

diseases.diseases.

Vaccination process: An Vaccination process: An interaction between the vaccine interaction between the vaccine agent and the human organism agent and the human organism

with its individual with its individual characteristics. It is a complex characteristics. It is a complex

reaction, which includes a reaction, which includes a fol lows:fol lows:

> Specific immune reorganization > Specific immune reorganization resulting in development of resulting in development of immunity (the aim of the immunity (the aim of the immunization)immunization)

> Concomitant process of non-> Concomitant process of non-specific reorganization ( directed to specific reorganization ( directed to restoration of the homeostasis) as restoration of the homeostasis) as well as allergization, cl inically well as allergization, cl inically manifested or a symptomatic.manifested or a symptomatic.

Different preparations are used Different preparations are used for development of immunity- for development of immunity- vaccines, toxoides, serums, vaccines, toxoides, serums,

immunoglobulins.immunoglobulins.

Live vaccinesLive vaccines

Immune preparations, containing Immune preparations, containing bacteria and viruses that have lost bacteria and viruses that have lost their immunologic properties. Such their immunologic properties. Such

types of vaccines are as follows: types of vaccines are as follows: against Tuberculosis, Polyomielit is against Tuberculosis, Polyomielit is ( oral vaccine), Measles, Mumps, ( oral vaccine), Measles, Mumps, Rubella, Plague, Tularemia, etc.Rubella, Plague, Tularemia, etc.

These vaccines develop intensive These vaccines develop intensive and longer immunity.and longer immunity.

Inactivated vaccinesInactivated vaccines

They are prepared from the They are prepared from the cultures of different infects, cultures of different infects,

inactivated physically ( heating inactivated physically ( heating up) or chemically ( formalin, up) or chemically ( formalin, alcohol) – Abdominal typhus, alcohol) – Abdominal typhus,

Cholera, Polyomielit is, as their Cholera, Polyomielit is, as their immunogenic properties are immunogenic properties are

preserved.preserved.

Recombinant vaccinesRecombinant vaccines

They are made with the help of They are made with the help of gene engineering with hybrid gene engineering with hybrid technology- Viral hepatit is B. technology- Viral hepatit is B.

ToxoidesToxoides

They are derived from the They are derived from the microorganisms, mainly their microorganisms, mainly their

toxins, through their toxins, through their inactivation ( by formalin or inactivation ( by formalin or

heating-up) – against heating-up) – against Diphtheria, Tetanus.Diphtheria, Tetanus.

Protective antigensProtective antigens

Immunizations ubstances related Immunizations ubstances related to the pathogenic factors of to the pathogenic factors of

bacterial and virus cells. Such bacterial and virus cells. Such antigens are discovered lately antigens are discovered lately

in Plague and Whooping- cough in Plague and Whooping- cough bacteria, Anthrax bacil l i , bacteria, Anthrax bacil l i ,

Rickettsias, etc.Rickettsias, etc.

SerumsSerums

Immune preparations proving Immune preparations proving passive immunologic prevention passive immunologic prevention for as short t ime ( 2-4 weeks). for as short t ime ( 2-4 weeks).

They are ready- made They are ready- made antibodies ( Anthrax, Tetanus, antibodies ( Anthrax, Tetanus,

Botulism, Diphtheria).Botulism, Diphtheria).

Application of vaccines, serums and Application of vaccines, serums and immunoglobulinsimmunoglobulins

Sub cutaneous, intra dermal (for Sub cutaneous, intra dermal (for serums strictly according to the serums strictly according to the method of Bezredka), per oral, method of Bezredka), per oral, trans nasal, aerosol method.trans nasal, aerosol method.

Post immunization reactions of the Post immunization reactions of the organismorganism

General- changes in the body General- changes in the body temperature and state of the temperature and state of the organismorganism

Local- hyperemia and edemaLocal- hyperemia and edema

Post immunization complicationsPost immunization complications

Serum disease, anaphylactic Serum disease, anaphylactic shock, post vaccination shock, post vaccination

encephalit isencephalit is

ContraindicationsContraindications

Severe state of the organism- Severe state of the organism- acute inf. disease, active form acute inf. disease, active form of tuberculosis, decompensated of tuberculosis, decompensated cardial diseases, hypertension, cardial diseases, hypertension, renal diseases ( nephrit is), renal diseases ( nephrit is), diabetes, pregnancydiabetes, pregnancy

Specif ic for the diseaseSpecif ic for the disease

The effect of immunization depends The effect of immunization depends on:on:

Compatibil i ty of the immunizationCompatibil i ty of the immunization The scheme and doses of the The scheme and doses of the

vaccinesvaccines Reactivity of the organismReactivity of the organism Size of the immune layerSize of the immune layer

Disinfection of the centre of Disinfection of the centre of infectioninfection

It is carried out in the centre of It is carried out in the centre of infection. Its aim is the infection. Its aim is the

elimination of the pathogenic elimination of the pathogenic microorganisms in the microorganisms in the

environment of the patient environment of the patient producing the microorganisms producing the microorganisms

and contaminating the and contaminating the environment.environment.

Disinfection performed during the Disinfection performed during the course of the disease is called course of the disease is called

current disinfection. current disinfection. After After recovery of the patient, i ts recovery of the patient, i ts

hospitalization or after a lethal hospitalization or after a lethal outcome- the outcome- the final (ending)final (ending) disinfectiondisinfection is performed. is performed.

The quality of the current The quality of the current disinfection determines the disinfection determines the

complex of methods and means complex of methods and means for the final disinfection.for the final disinfection.

Steri l izationSteri l ization

A method for elimination of all A method for elimination of all microorganisms ( pathogenic, microorganisms ( pathogenic, saprophyte, viruses, bacteria) saprophyte, viruses, bacteria)

in their different forms- in their different forms- vegetative and spores.vegetative and spores.

SanitationSanitation

A method for the rapid reduction A method for the rapid reduction of the microbial f lora in an of the microbial f lora in an

object in the environment. It is object in the environment. It is widely applied in every day l i fe widely applied in every day l i fe

as a preventive measure.as a preventive measure.

Antiseptic methodAntiseptic method

A method for prevention of A method for prevention of development of microorganisms development of microorganisms of the human skin and mucous.of the human skin and mucous.

Disinsection and derratizationDisinsection and derratization

Elimination of the arthropods, Elimination of the arthropods, carriers of inf. diseases.carriers of inf. diseases.

Elimination of the rodents, Elimination of the rodents, natural reservoirs of infections.natural reservoirs of infections.

Methods of disinfectionMethods of disinfection

Biological method- biological f i l ters Biological method- biological f i l ters for decontamination of the water for decontamination of the water ( on the base of the microbial ( on the base of the microbial antagonism)antagonism)

Physical method- sun shining, Physical method- sun shining, ultraviolet rays, ionizing radiation, ultraviolet rays, ionizing radiation, ultrasound, dry heat for steri l ization ultrasound, dry heat for steri l ization by dry air, wet heat- steri l ization by dry air, wet heat- steri l ization and vepour under pressureand vepour under pressure

Mechanical method – cleaning, Mechanical method – cleaning, wash, etc.wash, etc.

Chemical method- use of Chemical method- use of chemical compounds- chemical compounds- disinfectantsdisinfectants

Methods of disinsectionMethods of disinsection

>> Biological method- use of the Biological method- use of the natural enemies of the harm natural enemies of the harm

arthropods- predatory animals ( arthropods- predatory animals ( the f ish Gambusia), parasites, the f ish Gambusia), parasites,

pathogenic microorganisms pathogenic microorganisms ( Bacil lus thuringiensis), ( Bacil lus thuringiensis),

genetical hanged, sexually genetical hanged, sexually steri l populationsteri l population

Mechanical method- cleaning, Mechanical method- cleaning, washwash

Physical method- high Physical method- high temperature- hot dry and wet temperature- hot dry and wet air for vapouring, steri l ization, air for vapouring, steri l ization, burning outburning out

>> Chemical method- insecticides:Chemical method- insecticides:- Larvicides- for elimination of Larvicides- for elimination of

larvaelarvae- Acaricides- for el imination of Acaricides- for el imination of

acarsacars- Ovocides- for el imination of Ovocides- for el imination of

eggseggs- Pesticides- for elimination of Pesticides- for elimination of

weedsweeds

Attractants- attracting insectsAttractants- attracting insectsRepellents- repell ing insectsRepellents- repell ing insectsInsecticides for arthropods Insecticides for arthropods

depending on their way of depending on their way of penetration in the organism are penetration in the organism are as follow:as follow:

- Fumigants- gas insecticides- Fumigants- gas insecticides- they act trough the respiratory they act trough the respiratory systemsystem

- Intenstinal insecticides- trough Intenstinal insecticides- trough the digestive tractthe digestive tract

- Contact insecticides- act at Contact insecticides- act at contact to outer parts of the contact to outer parts of the insectsinsects

Methods of derratizationMethods of derratization

Preventive derratization:Preventive derratization:- Sanitary and technical means- Sanitary and technical means-

lack of access of the rodents to lack of access of the rodents to the buildings- openings of the buildings- openings of drainage, door sti l lsdrainage, door sti l ls

- Sanitary and hygienic Sanitary and hygienic measures- lack and access to measures- lack and access to foodfood

Exterminatory derratization:Exterminatory derratization:- Biological method- natural Biological method- natural

ki l lers of the rodentskil lers of the rodents- Mechanical method- use of Mechanical method- use of

trapstraps- Chemical method- use of Chemical method- use of

chemical compounds- chemical compounds- rodenticidesrodenticides