Infectious diseases of childhood

INFECTIOUS DISEASES OF CHILDHOOD

Infectious diseases are caused by pathogenic bacteria or other microorganisms that multiply in the body and have a harmful effect on it. These organisms (germs and viruses) are capable of producing poisonous substances, or toxins, that poison the body.

The chief source of infection is direct or indirect contact with the patient himself, the disease being communicated to others either before it has been recognized and the individual isolated, or transmitted after quarantine has been removed.

According to the mode of infection contagious diseases may be classified as:

I. Infectious diseases in which the infecting organism penetrates
through an abrasion or wound of the skin or mucous membranes.
Such are, for example, pyogenic bacteria, causing septicemia,
gonococcus infection, toxemia.

II. Infections caused by the pathogenic microorganisms through
the respiratory tract are: a) diseases due to various types of
streptococci: rheumatic fever, quinzy, scarlet fever; b) diseases due
to filtrable viruses: measles,.mumps, smallpox, chicken-pox, polio­
myelitis.

III. Infections, generally bacterial, disseminated principally by the
intestinal discharges, such as typhoid fever, dysentery, cholera.

In order to identify the causative microorganism bacteriological studies are performed which help to detect such microorganisms by direct examination under the microscope of the patient's blood, urine, stools, sputum or of any pathological material withdrawn from the body. The examination of the exudate on the tonsils, for example, may reveal the presence of the diphtheria bacillus; examination of the sputum may show the tubercle bacillus.

The direct identification of the infecting agent being impossible, the serologic method is used. The latter depends upon the demonstration in the patient's serum of antibodies specific to the suspected disease. Special serologic tests have been -devised for

demonstrating the presence of these antibodies. Among these are hemagglutination (inhibition), complement fixation, antibody neutral­izing, hemadsorption inhibition, and precipitation test. The method of immunofluorescence consisting of detecting specific antigens in the material studied by means of luminescent microscopy has proved of great diagnostic value.

Exercises

I. Translate into Russian the underlined words:

I. The disease can be communicated to other people. 2. Scarlet
fever is a contagious disease. 3. The infecting organism penetrates
through a wound of the skin. 4. Some infections are spread by
the intestinal discharge. 5. The causative microorganisms are
detected by examination of pathological material withdrawn from
the body. 6. For demonstrating the presence of the antibodies
special serologic tests have been devised.

 

II. Check if you remember the meaning of the following words:

Poison; discharge; capable; to multiply; to recognize; to remove; to depend on; to reveal; to suspect; to prove.

 

III. Using the words given below fill in the gaps in the sentences:
1. Influenza is an....2. Influenza is.... 3. Children... with

influenza get treatment at home. 4. The... agent penetrates through the skin. 5. You may... the wound if you do not dress it. 6. Pneumonia is an acute... disease. 7. This... is transmitted through the air.

Infect, infectious, infection, infecting, infected.

IV. Compare the sentences and say in which way they differ in their sense(translation) and grammatically:

a) Infections caused by the pathogenic microorganisms include
two types of diseases.

b) These infections are caused by the pathogenic microor­
ganisms.

c) Some infections may be caused by viruses.

d) Bacteriological studies performed to detect the causative
microorganism gave positive results.

e) Bacteriological studies were performed in order to detect
the causative microorganisms.

f) Bacteriological studies have been performed in order to
detect the causative microorganisms.

 

'V. Answer the questions on the text:

I. What pathogenicagents can cause an infection? 2. What is the classification о{ contagious diseases based on? 3. What are the ways in which the infecting organism penetrates into the human body? 4. What

methods are used to detect the causative microorganism? 5. What kinds of serologic tests are mentioned in the text?

II

The characteristic feature of acute infectious diseases is their cyclic course. There are clearly defined stages in the course of infectious diseases: incubation (latent period), prodromal period, invasion period, active period, period of decline, convalescence.

The maximum period of incubation (i.e., the time between the date of exposure to the disease and the beginning of clinical manifestations) of some communicable diseases, e.g., chicken-pox, measles, scarlet fever, small-pox, whooping cough, ranges between 7 to 21 days.

In some cases an increased resistance to certain infections can be observed. The capacity possessed by the body for resisting infection is spoken of as immunity.

Immunity may be natural and acquired. Natural immunity to certain infections may be transmitted from parent to offspring. A temporary passive immunity is transmitted from the mother to her infant both through the placental circulation and through the breast milk. Acquired immunity may follow a spontaneous attack of disease, the artificial inoculation of a modified virus, vaccine injections, injections of antitoxic and antibacterial sera.

The most significant primary preventive measure is immunization against contagious diseases. Prophylactic measures applied in early childhood and the preschool ages should be directed at combating acute childhood infections.

The medical science is now armed with reliable weapons for preventing infectious diseases. The treatment of infectious disease includes the methods directed against the causative agent and its toxins, as well as the microbes of the secondary complication (treatment with sera, sulfa drugs, antibiotics), and the methods which favourably influence the reactivity of the organism and the patient's emotional tone (blood transfusion, administration of blood plasma and serum, gamma globulin, physiotherapy, etc.). In addition, the complex of pathogenic therapy includes setting up a hygienic atmosphere for the patient, good care and a proper diet.

Exercises

I. Answer the questions on the text:

1. What are the stages in the course of infectious diseases? 2. What is immunity? 3. What are the kinds of immunity? 4. What is the most significant preventive measure against infectious diseases? 5. What does the treatment of infectious diseases include?

II. Check if you remember the meanings of the following words:

manifestation; inoculation; measure; resistance; to define; to transmit; to combat; to prevent; to acquire.

 

III. Translate the sentences paying attention to the underlined words:

a) A temporary passive immunity is transmitted from the mother
to her infant.

b) Children of the pre-school ages should also be protected
from infections.

c) Immunity may be transmitted from parent to offspring.

IV. Match the Latin words with their English equivalents and translate them into Russian:

L. Casus E. a course

Cursus a case

Causa a cause

V. Finish the sentences according to the following model:

First he looks for somebody and then he... (to look, for, everybody). First he looks for somebody and then he is looked for by everybody.

1. First the chief nurse instructs the other nurses and then
she... (to instruct, the doctor).

2. First the manager controls the workers and then he... (to
control, the director)..

3. First the little boy feeds his dog and then he...(to feed,
his mother).

4. The mother looks after her children and when she is ill
she... (to look after, they).

 

 

Part I

INFLUENZA

Influenza is an acute infectious disease. It is caused by a filtrable virus. The disease spreads very rapidly and affects the adult population and children. The incubation period is 1-3 days. The onset is sudden with a chill, high temperature, bad headache, pain in the eyes, back, joints and muscles. There is also a dry cough. There may be sore throat, sneezing and cold in the head.

The diagnosis is not difficult during an epidemic. With the onset of symptoms the patient must be put in bed. He should stay there until the temperature is normal for at least 3 days. The disease may have numerous and dangerous complications, such as: otitis media, bronchitis, pneumonia and so on. In a mild case the recovery is the rule. But during epidemics death may occur.

As to treatment it depends on severity of the disease. Proper nursing, hygiene and diet are very important. The patient's room must be constantly aired. In warm weather the patient may be kept outdoors or in the room with windows wide open all day Patients should always be given plenty of fluid to drink. Such medication as “antigrippin” (a combined anti-influenza medicine), different anti-viral drugs (such as arbidol, remantadin) are used. Herbal and homeopathic remedies can greatly relieve the patient’s condition..

Words to be memorized

Nouns: disease, onset, chill, headache, pain, throat, sneezing, cold, cough, recovery, death, treatment, severity, remedy, case.

Verbs: to cause, to stay, to occur, to depend (on, upon), to air, to relieve, to affect.

Adjectives: acute, dangerous, numerous, mild, proper.

Other words and expressions: as to, at least, such as, and so on, constantly, daily.

Read correctly.

Muscle [m^sl], muscular ['rruskjuld]; influenza ['influ'enza]; homeopathic [‘homie’paeOic]

Exercises

PNEUMONIA

Pneumonia is a specific acute disease which involves an entire lung or a part of a lung. Sometimes both lungs are involved. It

may occur at any time of year, but it is frequent in the months from December until May. The chief predisposing factors are. weather, draughts, loss of sleep and contact with patients who have infections. Various viruses and staphylococci may cause it.

The main symptoms are chill, fever, general weakness, sweating and persistent dry cough which can’t be relieved by common measures. The child usually has poor appetite, disturbed sleep. Sometimes children have local chest pains or stomachache. Young infants suffer from shortness of breath.In severe cases patients may have expectoration of bloody sputum. The disease sets in abruptly. There may be a preceding upper respiratory infection with a cough. If the disease remains uncomplicated if lasts from 7 to 14 days.

The treatment consists chiefly of bed rest. The most important agents are fresh air, good nursing and nutritious food that the child likes.The disease responds very well to specific medication with appropriate antibiotics (penicillin) Before the era of antibiotics sulfanilamides were used.. Mustard plasters are always administered, sometimes cups as well.. Diathermy of the lungs gives very good results. The child should be given vitamins C, A and others from the very first day of the disease.

A variety of complications may occur. Sometimes empyema develops after the seventh day of the disease. Otitis media and mastoiditis are usually found in children. Other complications are pericarditis, endocarditis and meningitis,.

An important factor in the prophylaxis of pneumonia is fighting such infectious diseases as influenza, measles and whooping cough, all of which are often complicated by pneumonia.

Words to be memorized

Nouns: fever, lung, chest, stomachache, weakness, sweating, expectoration. Verbs: to involve, to set in, to complicate, to last, to consist, to administer, to remain.

Adjectives: entire, frequent, chief=main, bloody, nutritious, common.

Other words: abruptly, chiefly.

Read correctly

Pneumonia [nju'mounja]; upper respiratory [‘respireteri] infection; empyema [empai'i:ma]; otitis media [o'taitis 'mi:dia]; mastoiditis [mastdi'daitis]; sputum ['spju:tum]; whooping cough ['hupin. 'kof].

Exercises

I. Answer the following questions:

I. What kind of disease is pneumonia? 2. In what seasons does it occur? 3. What are the chief predisposing factors to this disease? 4. What are the main symptoms of pneumonia? 5. How long does it last? 6. Are there any complications after pneumonia? 7. What is the commonest complication? 8. What does the treatment of pneumonia consist of? 9. What medicine

is prescribed for pneumonia? 10. What procedures are administered for severe cases of pneumonia? 11. When are vitamins given to the pneumonia patient? 12. What diseases are complicated by pneumonia?

II. Ask your friend yes/no questions:

The position of the sick child must be changed frequently; the room should be aired frequently; the sick child should be provided with good nutrition and care; the sick child must be allowed to lie on his back for long; the sick child should be kept in bed; the sick child may be kept outdoors.

III. Read the text and say what new information it contains as
compared with the previous text:

Pneumonia almost always sets in abruptly with a high fever. Children often complain of stomachaches and pain in the chest. Sometimes children expectorate bloody sputum. The cough is at first very mild, in some cases it is absent altogether. Respiration is accelerated. The disease lasts 7-14 days. In older children complications are rare, and prognosis is very good. Proper treatment and nutrition lead to complete recovery.

IV. Translate into Russian paying attention to the meaning of the underlined words:

1. Pneumonia involves an entire lung or a part of a lung. 2. The disease responds very well to specific medication with penicillin. 3. The doctor applied mustard plasters on the patient's breast and cups on his back. 4. Children are given vitamins from the very first day of the disease. 5. A variety of complications may occur. 6. If you sit near the window, you will get a cold. There is a draught there.

V. Match the underlined words with their Russian equivalents and translate the sentences:

1. This food is very nutritious, а) частый, часто

встречающийся

2. The disease sets in abruptly b)корь

3. During this season the disease is very с) резко, внезапно
frequent d)питательный

4. Pneumonia may complicate е) коклюш
whooping cough.

5. Measles may also be complicated by pneumonia..

VI. Speak about: a)symptoms and course of pneumonia; b) com­
plications of pneumonia; c) treatment of pneumonia; d) care for a pneumonia patient.

WHOOPING COUGH (PERTUSSIS) '

Whooping cough is a common acute infection of childhood, highly contagious. It is caused by the Bordutellia Pertussis. The illness is characterized by a catarrhal period of nonspecific respiratory symptoms progressing to the stage of paroxysmal cough, accom­panied by the typical inspiratory whoop and vomiting. It may be complicated by potentially serious involvement of the respiratory tract and the central nervous system.

Epidemiologic Factors. The disease may strike at any time of the year. Although no age is exempt from pertussis, most people have the disease in early life. Transmission is likely to occur by direct contact with an infected person (coughing, sneezing, talking). The disease is communicable from its very first days to four weeks afrer onset of typical paroxysms.

Clinical Manifestaions. The incubation period is about 7 days, seldom shorter — from 2 to 4 days, or longer — up to 21 days.

The clinical course of whooping cough is divided into 3 stages — catarrhal, paroxysmal and convalescent. The. catarrhal stage lasts for about 1 or 2 weeks. It begins with the symptoms of an upper respiratory infection or common cold. The child may appear listless and irritable. Sometimes the only manifestation is a dry hacking cough. After about a week the cough, instead of improving, gradually becomes more severe and it begins to occur in paroxysms. The paroxysmal stage lasts, as a rule, 4 to 6 weeks. The cough now comes in explosive bursts. A series of 5 to 10 short, rapid coughs are given on one expiration, followed by a. sudden inspiration, associated with a characteristic sound or whoop. During the attack the child's face becomes red or cyanotic, the eyes bulge, the tongue protrudes. Vomiting frequently follows the attack. In severe cases young unimmunized infants may stop breathing during an attack (apnea).The attacks occur more frequently at night and in a stuffy room than in one well aired or out of doors.

The convalescent stage is marked by cessation of whooping and vomiting. Little by little the number and severity of paroxysms decrease.

Diagnosis. The clinical diagnosis is made by the paroxysmal nature of the cough, the red or cyanotic appearance of the child during an attack and the associated vomiting. During the catarrhal stage it is usually impossible to differentiate pertussis on clinical grounds from the common cold, bronchitis or acute respiratory disease.At this time Bordutellia pertussis can be isolated from the nasopharynx. The white blood test may also help the diagnosis. High white blood counts with a predominance of lymphocytes are characteristic of whooping cough.

Treatment. There is no specific drug to stop the attacks. Modern cough suppressing remedies may be administered in severe cases.

Whooping cough can be effectively treated with antibiotics.. The sooner one of these antibiotics is used, the better the results. The course of antibiotics treatment averages 8—12 days. Rest in bed is indicated as long as fever is present. The room should be well aired. It is important to maintain proper nutrition. The diet must be adequate, rich in vitamins, especially vitamin С The patient should be separated from other people.

Complications. The commonest and usually the most severe complication is pneumonia. Stop of breathing during an attack is very dangerous in young children. Otitis media, atelectasis may often occur.

Immunity. As a rule, one attack of whooping cough is followed by life-long immunity. Second attacks of pertussis are rare.

Prophylaxis.- Children should be immunized at the age of 5-6 months with a pertussis - diphtheria vaccine.

Words to be memorized

Whoop; whooping cough; listless; hacking cough; stuffy

Read and translate the words with the same root:

Immune, immunity; complication, complicate, complicated, uncomplicated; danger, dangerous; severe severity; especially, special; important, importance; separate, separately, separation; suppressing, suppression, pressure; predominence, dominant.

Exercises

I. Answer the following questions:

I.What kind of disease is whooping cough? 2. What is it caused by? 3. What is the illness characterized by? 4. What age may be affected? 5. How is the disease transmitted? 6. What period of whooping cough is communicable? 7. How long does the incubation period last? 8. What stages is the clinical course divided into? 9. What are the symptoms of the catarrhal stage? 10. How long does the paroxysmal stage last? 11. What are the manifestations of the paroxysmal stage? 12. What does the treatment of whooping cough consist of? 13. What complications may follow the disease? 14. Is whooping cough followed by lasting immunity?

VII. Translate into Russian

Cough is a protective reflex, its purpose being expulsion of respiratory secretions or foreign particles from air passages. It occurs due to stimulation of mechano- or chemo- receptors in throat, respiratory passages or stretch receptors in the lungs. Cough may be useful or useless. Useless (unproductive) cough should be suppressed. Useful (productive) cough serves to drain the airway. Its suppression is not desirable, it may even be harmful, except if the amount of expectoration achieved is small compared to the effort of continuous coughing.

 

CHICKEN-POX

Chicken-pox is a very contagious disease of children. The disease occurs in epidemics, especially in children under the age

of ten years. Children of-the first four years of life are the most susceptible. There is an incubation period of 14—21 days, most frequently 17 days.

The first symptoms are the following: a slight fever and sometimes pains in the back and legs. Almost at the same time (within twenty four hours) a characteristic eruption appears on different parts of the body. It is found very frequently on the scalp (the hairy part of the head).

The eruption consists of red macules quickly progressing to papules and vesicles. Soon they become crusted. The brownish crusts dry up and fall off in two – three weeks. The child remains infectious until the scabs scale.

The number of vesicles is very variable. In a slight case there may only be eight or ten of the vesicles, but sometimes in severe cases their number may amount to six or seven hundred.

In the vast majority of cases there is no difficulty in making a diagnosis, but a doctor must learn how to differentiate it from other skin disorders especially from smallpox.

Chicken-pox is one of the mildest of acute infectious diseases of children. Children remain feverish for 2 – 3 days, while new vesicles still appear and after that feel well.The recovery is usually complete. Complications are rare. Encephalitis may occur in uncommonly severe cases..

In the majority of cases no other treatment beyond isolation is required. The child should be kept in bed during the eruptive stage and as long as there is any fever. The lesions should be treated with a disinfective solution.

Words to be memorized

Nouns: vomiting, eruption, crust, scab, disorder, complication,lesion

Verbs: to appear, to burst to amount, to dry up, to fall off, to scale, to include, to require.

Adjectives: contagious, susceptible, slight, brownish, variable, severe, complete, rare, eruptive, common..

Other words and expressions: frequently, beyond, almost.

Read correctly

macule ['maekjul] — пятно, vesicle ['vesikl] — пузырек, smallpox ['smo:lpoks] — ocna chicken-pox f'tjikin'poks] — ветряная оспа

nephritis [ne'fraitis] — нефрит (заболевание почек), encephalitis [en,sefo'laitis]— воспаление головного мозга (эн­цефалит)

Exercises

I. Answer the following questions:

1. What kind of disease is chicken-pox?

2. What is the most characteristic symptom?

3. What age is affected by the disease?

4. Is the incubation period long?

5. What are the first symptoms?

 

6. When does the eruption appear?

7. What does the eruption consist of?

8. On -what part of the body does the eruption appear?

9. How many vesicles may be on the skin?

 

10. What is the duration of this disease?

11. What treatment is required?

12. Is it difficult to make a diagnosis?

13. What must the doctor keep in mind making a diagnosis?

14. Is chicken-pox usually mild or severe? What shows this?
II. Ask him (her) if chicken-pox is an infectious disease

the disease affects children under ten

the incubation period of chicken-pox is long chicken-pox is accompanied by an eruption isolation is necessary in case of chicken-pox Ask him (her) what the disease is characterized by whom the disease affects how long the incubation period is what the symptoms of the disease are when the eruption appears what the eruption consists of where the eruption appears

how many vesicles appear in a slight case (in a

severe case) when the recovery begins.

 

III. Translate the following sentenses:

a) 1.No special treatment is required in case of chicken-pox.

2.Chicken-pox does not occur in adults.

3.Chicken-pox is not a dangerous disease.

4.The doctor found no eruption on the back of the patient.

5.The sick boy did not attend school during 5 days.

6.As a rule chicken-pox has no complications.

7.The patient was not taken to the hospital because he had

no symptoms of any infectious disease.

8. The patient had no symptoms of scarlet fever. There was

no rash on his neck, chest or extremities.

9. The child felt no pain in the throat.

b) 1.There should be an immunity after a spontaneous attack of chicken-pox.

2.There may or may not be a preceding upper respiratory infection with cough.

3.In a mild case of chicken-pox there may be eight or ten vesicles, but in a severe case there may be six or seven hundred of them.

4.There may occur such complications as nephritis, pneumonia and encephalitis.

5.If there is chicken-pox, there must be skin eruption.

c) 1.Chicken-pox is known to be transmitted by droplets.

2. Treatment of chicken-pox must be aimed at controlling the fever and relieving the itching.

3. Where is Dr.Brown? He may be examining a child with some rash admitted to the hospital.

4. She must have been treated in hospital because of the severe complication after chicken-pox

5. Chicken=pox may be a serious disease for adults who may have been infected with AIDS; it may be treated with ciclovir..

 

IV. Translate from Russian into English:

1. Сегодня у больной не болит голова.

2. Мой друг сейчас не в больнице, он в санатории.

3. Я не пойду в палату, так как у меня нет халата.

4. У нас вчера не было практики в клинике.

5. Больной не чувствовал никакой боли в пояснице.

6. Я не болел пневмонией в раннем возрасте.

7. У меня не было осложнений после гриппа.

8. Я не буду принимать это лекарство. 9. Врач вчера не оперировал.

 

10. У нас не будет лекции по анатомии в понедельник.

11. В кабинете врача никого не было.

 

V. Read the text and say what new information it contains as compared with the previous text:

In the vast majority of cases of chicken-pox the eruption is the first sign of the disease and the rash is not preceded by a prodromal illness.

Mothers usually state that the first symptom to attract attention was the rash. There may be some mild constitutional symptoms, such as malaise and a slight temperature. These may vary in duration from a few hours to two or three days. The child may appear restless and slightly feverish the night before the rash appears. Adults, on the other hand, are very apt to -have a well-defined series of prodromal symptoms, such as chill, fever, nausea, loss of appetite, backache, etc.

 

VI. a) Speak about the symptoms of chicken-pox.

b) Describe the period of eruption.

c) Read what a crust, or a scab, is and explain it in English:

Crust is a formed outer layer< especially an outer layer of solid matter formed by the drying of a bodily exudate or secretion; it is also called scab.

SCARLET FEVER

Scarlet fever is an acute contagious disease characterized by high temperature, rapid pulse, a punctate eruption 'followed by desquamation, inflammation of the throat. It is caused by Hemolitic Streptococcus.

The disease may be transmitted either by various objects — clothing, toys, books and food-stuffs, infected by the patient or by means of droplet infection (during coughing, sneezing or talking).

All children are susceptible, particularly frequently between 18 months and 10 years of age. Adults also contract this illness, but they have only sore throat without the eruption characteristic of scarlet fever.

The incubation period of the disease lasts on an average 4—7 days; sometimes it only jtakes a few hours.

The onset of the disease is sudden. There is generally a very sore throat, a sharp rise of temperature to 39 — 40°C, nausea, vomiting, headache and often chills. The lymphatic nodes of the neck are enlarged. The child' is restless and sleeps badly.

Within a few hours, but more often at the end of the first or in the beginning of the second day a diffuse red rash appears on the neck, chest and back, spreading to the arms and legs. The area around the mouth remains free from rash. The rash lasts one or three days and then fades away. After the disappearance of the rash the period of desquamation begins. Desquamation continues 10—14 days.

If no complications develop and patients feel good they are allowed out of the bed after the 7^th day of the disease. They may be discharged from the hospital on the 12—14^th days.

The principal complications are acute nephritis, adenitis, otitis media, pericarditis, endocarditis, etc.

Scarlet fever patients should be isolated and stay in bed. Careful disinfection of the patient's things is important. Antibiotics are prescribed.

Words to be memorized

Nouns: scarlet fever, rash, neck, desquamation, adult, nausea, illness, inflammation, course, disappearance.

Verbs: to transmit, to contract, to simulate, to enlarge, to fade away, to discharge, to spread.

Adjectives: rapid, direct, sudden, sharp, restless, careful.

Other words and expressions: either... or, by means of, particularly, a few.

Read correctly

adenitis f,edi'naitis] — аденит, воспаление лимфатического узла pericarditis [,perika:'daitis] — воспаление сердечной сумки, пе­рикардит.

Exercises

I. Answer the following questions:

1. What kind of disease is scarlet fever?

2. What symptoms is it characterized by?

3. How is this disease transmitted?

4. What children are susceptible to scarlet fever?

5. Do adults contract scarlet fever?

6. How long does the incubation period last?

7. How does scarlet fever begin?

8. When and where does the rash appear?

9. How long does the rash last?

10. What is the eruption followed by?

II. What is the most communicable period?

12. What measures must be taken with the appearance of the
first symptoms? -

13. What are the principal complications?

14. How is this disease treated?

 

II. Ask her (him) whether there are any characteristic symptoms
of scarlet fever; there is always eruption in case of scarlet fever;

there is any incubation period in case of scarlet fever; there is always' a rise in temperature in case of scarlet fever; there are serious complications after scarlet fever.

 

III. Translate the following sentences:

1. The rash lasts 1—3 days and is then followed by desquamation.

2. Serious complications such as nephritis, otitis and affections
of the joints may follow any stage of scarlet fever.

 

3. Even mild cases of scarlet fever may be followed by late
complications.

4. In very young children the onset of pneumotia is frequently
not associated with any preceding infection (influenza). In other
cases case history shows influenza, followed by dyspnea.

5. Bronchopneumonia in infancy follows a very diverse course,
ranging from cases with a mild form to severe toxic or, septic
forms that are frequently followed by grave complications.

IV. Read the text

. Say what information is new as compared with the first text about scarlet fever.

Scarlet Fever

In this infection, certain Streptococcus bacteria enter the body through the pharynx, or throat, and cause an attack of tonsillitis. Without antibiotic treatment, the bacteria multiply and produce a toxin, or poison, that circulates in the blood. After an incubation period of one to seven days, the amounts of toxin are sufficient to cause the symptoms of scarlet fever.

What are the symptoms?

The symptoms do vary slightly from person to person. Here is a typical case of scarlet fever.

On day one the child develops a high fever (as high as 104 degrees F, or 40 degrees C), a red, sore throat and tonsils, and a furred tongue. Sometimes a whitish coating covers the tonsils and the child may vomit.

On day two a bright red (scarlet) rash appears on the child’s face, except for just around the mouth. By day three this rash, which may itch, has spread to cover the rest of the body and the arms and legs. Meanwhile the child’s temperature starts to fall and the tongue becomes bright, strawberry-red.

By day six the rash has faded. Both skin and tongue may begin to peel, leaving a red, raw surface underneath. Peeling can last another 10 to 14 days.

Scarlet fever now has become rare. The two main risks, both very rare and occurring about two to three weeks after the rash, are rheumatic fever and a form of glomerulonephritis.

Parents of the child should contact the physician if you suspect your child has scarlet fever. Follow the advice of the doctor and you can expect a full recovery with no after-effects.

 

V. a) Speak about 1) the symptoms of scarlet fever
2) the course of the disease.

b) Describe 1) how scarlet fever is transmitted 2) how eruptionappears and spreads

 

MEASLES

Measles is one of the most communicable and widespread diseases of childhood. All the parents must know that measles is a very grave disease which is dangerous for children especially the young ones.

The disease is spread by infected droplets from the nose and throat sneezed or coughed into the air.

There is an incubation period of 9—10 days. The first symptoms are fever, cough and sneezing. With the appearance of these symptoms the parents must put the child into bed and call the doctor in.

The disease is characterized by a rash which appears on the 4^th day,at first on the mucous membrane of the mouth, it is known as Filatov-Koplik's spots. These are tiny white spots on a bright red background. Then red maculopapular rash appears on the skin, at first behind the ears, then on the face, body and limbs. After the disappearance of the rash desquamation begins.

The patient begins to feel much worse. The cough and cold in the head become aggravated, the eyes get purulent. If the disease is not complicated, the patient recovers quickly.

Proper treatment and good nursing may prevent complications. The patient's room must be aired as often as possible, because fresh air prevents further infection, and it must be cleaned with a wet duster. The patient's bed must be placed so that the day light should not fall on his face, but the room must never be darkened because the sun rays kill bacteria.

It is necessary to keep the patient's mouth clean. For this purpose the patient should rinse his mouth after meals. Little children must drink boiled water instead of rinsing. If the child has no complications he must be bathed as usual. The temperature of the water must be about 36—37 °C. As the sick child has poor appetite he should take soft diet in small amounts 5—6 times a day. The patient's hands must often be washed and he must not be allowed to rub his eyes. It is good to wash his eyes out with tea (green tea is better) or an appropriate disinfecting solution several times a day. It is necessary to isolate the sick child from healthy children. When it is impossible for the child to have proper nursing at home, he should be taken to the hospital where there are proper conditions to aid his recovery.

Words to be memorised

Nouns: measles, membrane, limb, nursing, diet, amount, solution, condition.

Verbs: to prevent, to protect, to clean, to place, to kill, to darken, to drink, to rinse, to bathe, to wash out, to isolate, to expose.

Adjectives: widespread, grave, mucous, sick, clean, boiled

Other words and expressions: to put into bed, to call -a doctor in, at first, instead of, for this purpose, to get purulent — гноиться, to be vaccinated — сделать прививку Filatov-Koplik's spots — пятна Филатова-Коплика

 

Exercises

I. Answer the following questions:

1. What kind of disease is measles?

2. In what way is it spread?

3. How long is the incubation period?

4. What are the prodromal symptoms?

5. What must be done with the appearance of these symptoms?

6. What is the disease characterized by?

7. Which is the most characteristic symptom of this disease?

8. Where does the rash appear first?

9. What preventive measures must be taken to exposed
children?

10. When does desquamation begin?

11. What is the prognosis of the disease if it is not
complicated?

12. What measures usually prevent complications?

13. How must the sick child be nursed?

14. In what case is the patient taken to the hospital?

 

II. Translate the following sentences:

a) 1. Taken in time, any general well-known measures for given
disease bring good results.

2. The physician observed marked improvement obtained due
to proper treatment.

3. If vaccinated in time, children do not develop dangerous
complications.

4. The child exposed contracted measles.

b) 1.Measles being an infectious disease, the sick child must be isolated as soon as possible.

2. Measles begins like a bad cold, catarrhal symptoms such as a runny or blocked nose, sneezing, coughing and others being present through the illness.

3. Measles appears to have been known from an early period in the history of medicine, it being mentioned in the writings of the Arabian physicians.

4. Measles is believed to be one of the most contagious diseases, its main symptom being a specific macular eruption which first appears on the mucous membranes of the mouth.

 

c) 1. One of the worst complications of measles, but fortunately
a rare one is gangrenous stomatitis.

2. Mild cases of measles are as contagious as severe ones.

3. If one finds characteristic spots on the mucous membrane
of the mouth, one should suspect measles.

4. One must keep in mind all measures that may prevent
complications.

5. Measles is more prevalent than any other eruptive fever and
one to which human beings are universally susceptible.

d)1.Считается, что корь – одно из самых опасных заболеваний детства.

2.Корь распространяется воздушно-капельным путём, причём дети легко заражаются, даже после короткого контакта.

3.Противокоревую вакцину рекомендуют вводить в возрасте 9-10 месяцев.

4.Если корь протекает тяжело, за ней могут последовать осложнения, такие как пневмония, бронхит и др.

5. Больного ребёнка можно лечить дома, но хороший уход крайне важен.

 

III. Read the text and say what new information it contains as compared with the previous text:

Measles is the commonest infectious disease of childhood. It is characterised by catarrhal symptoms of the eyes, nose and throat, fever and a typical eruption located on the mucous membranes and on the skin. Very young infants are relatively unsusceptible, especially if they are breast-fed. They become more susceptible after the sixth month and there is no infectious disease to which there is less natural immunity than to measles. The most frequent and most important complication of measles is the involvement of the respiratory tract (pneumonia, bronchitis). Middle ear inflammation sometimes occurs.

 

IV. Say what mother should do while looking after the baby
who has measles; speak about the period of rash

.

V. Using the Table of Infectious Diseases on p. 95 write down the facts about chickenpox, scarlet fever, measles.

Comparing the facts speak about a) the way of transmission; b) The duration of incubation period and complications of these three diseases, c) Eruptive stage of chicken-pox and scarlet fever, scarlet fever and measles.

 

 

INFECTIONS IN CHILDREN

Once healthy children are past the first few months of life they are able to combat infections as well as adults. During the first few months the child may not have developed a sufficient number of antibodies to be able to combat successfully the many bacteria in his environment.

The process of developing antibodies takes place rapidly after six months of age, and healthy children may show an even greater resistance to the ordinary bacterial infections than adults.

Children tend to develop an immunity to the bacteria that flourish in their environment. However, such bacteria as staphylo-coccus, streptococcus, colon bacillus, and others can cause an

infection if they gain access, to the child's body through a break in the skin or through one of his apertures.

There are some conditions which can affect a child's ability to combat an infection.

1. If a child is undernourished and lacks sufficient body proteins,
vitamins and essential minerals, he will be poorly equipped to
combat infections.

2. An anemic child will find it more difficult to mobilize his
body resources to combat infections.

3. If there is a disease in one of the major organs, such as
liver, kidneys, or bone marrow, a child will be less able to fight
off the invasion of bacteria.

Any infection may cause temperatures as high as 105 °F to 106 °F in a, child. This is not a bad indication, as it demonstrates the child's ability to mobilize his defence mechanisms.

It is necessary to give a patient large quantities of fluids because most generalized infections are associated with temperature elevation and profuse sweating. Furthermore, large quantities of fluids tend to dilute the toxins produced by the bacteria.

Bed rest and prompt treatment of minor infections such as head colds or other upper respiratory infections will often prevent the onset of a more serious infection such as pneumonia.

It must be remembered that antibiotics are usually ineffective in ridding the body of a viral infection. However, they may be given to prevent a secondary invasion of bacteria that would complicate the original viral infection.

In certain instances the vaccines are effective in preventing the viral infection but not in curing it. For example, the measles virus can be prevented from taking hold within the body by vaccinating the child against it.

DISEASE

DISEASE is the unhealthy state of a body part, a physiological system, or the body as a whole. A disease may be a structural anomaly, such as a congenital heart defect, or a functional condition such as high blood pressure or trauma.

An important aspect of any disease is its etiology. Many diseases are known to be caused by infectious agents for example, childhood infectious diseases; the common cold and the flu and catarrhal jaundice are considered to be viral infections while inflamatory processes and abscesses being caused by bacteria. Another important aspect of a disease is the way of its manifes­tation — the symptoms and signs.

Diagnosis, the determination of the nature of a disease, is based on many factors including the signs, symptoms and often, laboratory arid clinical findings. To make a diagnosis a physician obtains information from a physical examination, from interviewing the patient or a family member, as well as from a medical history of the patient.

The physician having made a diagnosis states the possible prognosis of the disease, the course it is to take and an outcome of the disease.

The treatment considered most effective should be prescribed and may include medication, surgery, radiation therapy, etc.

Physicians know the course of the disease often to vary. It may have a sudden onset and a short duration in which case it is stated to be an abute disease. A disease may begin insidiously curable one or have a fatal outcome.

 

Acute Tonsillitis

Acute tonsillitis is a systemic infection characterized by an acute inflammatory process, it may have drastic effect on many vital organs of the body.

Acute tonsillitis may be due to different bacteria. The most common cause is the haemolytic streptococcus. Its highest, incidence is between October and March. Care must be taken to prevent spread of infection. In the early stages it may be difficult to differentiate from diphtheria, and if there is any doubt as to diagnosis, a throat swab must be taken to determine the infecting organism. Acute tonsillitis is caused by the contact with infectious patients, through articles. The child may carry a dormant infection in his decayed teeth or chronically inflamed tonsils. And when his body is weakened or he is subjected to prolonged chilling he falls ill.

Protection against tonsillitis includes elimination of factors that lower resistance to disease. An important factor in the prevention of tonsillitis is the protection of healthy children against exposure to it and as well as to other diseases, such as upper respiratory catarrhs, grippe, colds.

There are several forms of acute tonsillitis, depending on the nature of the lesion: catarrhal, follicular and lacunar tonsillitis.

The onset of tonsillitis is usually sudden with malaise, pain on swallowing, a sensation of chilliness,.fever, impaired sleep and appetite. On examination one or both tonsils are found to be enlarged and covered with whitish or grey material.

This material or exudate consists of purulent discharge from the tonsil. The inflammatory process is seldom restricted to the tonsils, and the whole of the throat is reddened and inflamed. The tongue is covered with a thick fur, and the breath has often an unpleasant odour. There is sometimes pain in the ear on the affected side, it may lead to infection of the ear with serious consequences.

The most frequent complications of acute tonsillitis are rheumatic fever and kidney trouble. A condition called chronic tonsillitis may develop following recurrent.attacks of acute tonsillitis.

A sick child must be put to bed immediately. Particular care should be taken to give the child a lot of vitamins, the patient's food must be soft and warm. The children have to gargle their throats with a solution of salt, soda and boric acid. Vapour inhalations through the mouth are sometimes comforting. Warm compresses to swollen lymph nodes are useful. The drugs usually prescribed for acute tonsillitis are streptocide (sulfanilamide) or other sulfonamides. The child is given drugs to bring the t°down.

Chronic tonsillitis is treated by irrigating the tonsils with various preparations or exposing them to ultraviolet rays. The tonsils may be removed surgically if treatment is of no avail.

DIPHTHERIA

Diphtheria is an acute infectious disease caused by Corynebac-terium diphtheriae.The microorganism produces an exotoxin which is responsible for the resulting pathologic process. The disease is characterized clinically by a sore throat and a membrane which may cover the tonsils, pharynx and larynx.

Epidemiologic factors. The highest seasonal incidence occurs during the autumn and winter months.

Diphtheria is acquired by contact with either a case or carrier, the microorganisms being disseminated by the acts of coughing, sneezing or talking.

Pathogenesis and Pathology. Virulent diphtheria bacilli lodge in the nasopharynx of a susceptible individual. Bacterial growth taking place in the secretions and epithelial debris, a toxin is elaborated and absorbed by the local mucous membrane. The toxic effect on the cells causes tissue necrosis. In addition to the necrosis, an inflammatory and exudative reaction is also induced by the toxin. The necrotic epithelial cells, leucocytes, red cells, ftorinous material, diphtheria bacilli, and other bacterial inhabitants of the nasopharynx — all these elements combine to form the typical "membrane". It sloughs off during the recovery period.

Clinical Manifestations. Diphtheria develops after a short incubation period of 2 to 4 days.

For clinical purposes it is convenient to classify the disease in accordance with the anatomic location of the membrane. The following types of diphtheria may occur: (1) tonsillar (faucial), (2) laryngeal or laryngotracheal, (3) nasal and 4) nonrespiratory types including skin wounds, conjunctival and genital lesions.

Diagnosis. An early diagnosis of diphtheria is essential because delay of administration of antitoxin may impose a serious risk on the patient. The diagnosis of diphtheria must be made clinically.

The bacteriologic confirmation by means of culture is of the greatest importance. The method of accelerated bacteriological diagnosis when the material secured with the aid of a specially prepared moist tampon is placed in a thermostat for 4—6 hours should be more widely employed. A tellurium test has been recently employed as a method of rapid diphtheria diagnosis.

Treatment. It is necessary to isolate the patient at once. Diphtheria antitoxin must be given promptly and in adequate dosage. In severe toxic forms of diphtheria it is advisable in addition to the serum to administer intravenously a hypertonic glucose solution, give the patients vitamins in the form of nicotinic acid and ascorbic acid for a period of 2—3 weeks, some. authors recommending administration of atrychnine from the 1-st days of the disease. Bed rest is very important. Other supportive measures include maintenance of hydration, a high caloric liquid or soft diet rich in vitamins, aspirin or codeine for sore throat and malaise. The patient must gargle his throat several times a day with a 2% boric acid solution. The patient's room must be aired.

Patients with laryngeal diphtheria require special treatment. In very advanced cases with severe symptoms of growing asphyxia, if there is increasing restlessness, irritability and anxiety, associated with progressive respiratory distress, a tracheotomy is indicated for the relief of obstruction. It should be performed before the child becomes cyanotic and exhausted.

Prognosis and Complications, in spite of the low fatality rate sudden death may be caused by a variety of unpredictable events, such as (1) the sudden complete obstruction of the airway by a detached piece of membrane, (2) the development of myocarditis and heart failure, and (3) the late occurrence of the respiratory paralysis due to phrenic nerve involvement. Patients surviving following myocarditis and neuritis, the recovery is a rule.

Immunity. For determining immune status the Shick test is useful. Active immunity may be induced by either an attack of diphtheria or more commonly to-day by inoculations of diphtheria \ toxoid. Immunity following an attack of diphtheria may be either j, permanent or temporary; recurrent attacks of the disease are not \ unusual. The widespread and routine immunization of infants and

children having had a profound effect on the immune status of the population at large, the incidence of diphtheria among inoculated children is lower, and the disease runs a milder course.

BRONCHITIS

This is probably the most common respiratory disorder of childhood. The inflammation affects the mucosa of the bronchial system. In the majority of cases it is harmless, but in very young patients or those weakened by ill health, it may develop into bronchopneumonia.

Bronchitis may be primary, but is very often an accompaniment of some other infection, as tuberculosis, pneumonia, influenza, whooping-cough, diphtheria. Bronchitis may occur at any age.

Etiology. Bronchitis is due to virus and bacterial infection. The microorganisms most frequently found are the staphylococcus, strep­tococcus, pneumococcus.

Pathology. Bronchitis is usually part of a general inflammation which may include any or all of the respiratory tract. The infection can begin at any point, and extend down as far as the alveoli, where it results in pneumonia. In a simple case the changes are usually minor: hyperemia of the bronchial mucosa and desquamation of ciliated epithelial cells, with loss of cilia; the mucous glands become distended, the bronchial secretion increases.

Symptoms. The mildest form is confined to the larger tubes. The onset may be sudden or gradual sometimes accompanied by slight fever, from 37.7 °C to 38.8 X, during the first day or two usually there are but few general symptoms. Respiration may be accelerated, and is usually audible. There may be either constipation or diarrhea. The child may be restless and irritable, though giving little evidence of being sick. Catarrh of the upper passages may be associated. Usually there is a dry, hoarse cough, either mild or severe, which may interfere with the taking of food. There may be pain under sternum. When the inflammation reaches the inter­mediate tubes, the fever is usually higher for the first two or three days, after which it gradually declines. Both respiration and pulse are accelerated. In children over three years old bronchitis is not unlike that in adults. There is not the same danger as in infants, of the infection passing over into the smaller bronchi. Often there is no fever, the patient feels well and has a good appetite.;The symptoms are cough, which is worse at night and soreness over sternum. The cough is with a small amount of whitish expectoration. The cough usually lasts from one to two weeks. In severe cases older children may complain of headache, chilliness, pain in the back, and a feeling ef tightness in the chest.

Expectoration is more profuse, sometimes blood-streaked. Sometimes bronchitis may be more protracted; this is connected with the duration of the primary disease and with domestic conditions, particularly when the child is deprived of fresh air and sunlight for prolonged periods. Such unfavourable factors may lead to a number of complications auch as, otitis media, pyelitis, secondary anemia. Bronchopneumonia is the most frequent complication in infants.

Prognosis is good for acute bronchitis; in childhood the conversion to chronic forms is rare. Even in protracted cases uncomplicated by pneumonia complete recovery is often obtained by proper care and improved domestic conditions.

Treatment. Bronchitis usually requires only fresh air, good ventilation of premises, a well-balanced diet. Warm baths are indicated, especially for infants. Mustard plasters and mustard packs are recommended. The symptomatic drugs administered are usually expectorants or, on the contrary, anesthetics to keep the cough down.

ACUTE BRONCHITIS

Acute bronchitis is an acute disease of the bronchi, characterized by an inflammation of their mucous membrane, caused by the chemical and biological extension of irritation from the upper air passages, often following a rhinitis or a laryngotracheitis. The larger bronchi are first affected. Affection of the smaller bronchi may be secondary to affection of the larger tubes. Further spread of the infection may cause bronchopneumonia. The condition is also found in association with influenza, measles, scarlet fever, and some of the other acute febrile diseases.

Symptoms: These are retrosternal pain, hoarseness, cough, and often soreness; there may be a slight rise of temperature, though the temperature often remains normal.

Physical Signs: Inspection of the chest is negative; the trachea and pharynx may be infected. Nothing abnormal is elicited by palpation and percussion, but on auscultation the respiratory murmur may be harsh, and numerous large moist or dry rales are found along the large bronchi, which of.ten disappear after cough and expectoration.

CHRONIC BRONCHITIS

This is a chronic inflammatory condition of the medium sized and small bronchi, associated with destructive changes in the bronchial wall and peribronchial space. As a rule, it is a secondary

disease. It is characterized by dyspnea, cough and various types of expectoration.

Most cases of chronic bronchitis occur in those past middle life. In the young it may be caused 'by some irritating condition within the upper air passages, the trachea or the bronchi, and also by the presence of enlarged tonsils, sinus infections, focal infections, enlarged pendulous uvula, adenoids, congenital malfor­mation of the trachea. A foreign body in the bronchi or lungs may at times be the cause of chronic bronchitis.

Symptoms: These are cough which occurs in paroxysms, copious expectoration, absence of fever, and a history of long-standing cough.

Physical signs: A person suffering from chronic bronchitis is usually emphysematous. Inspection, therefore, will reveal an em-physematous chest. Palpation will give evidence of diminished tactile fremitus throughout the- chest. Percussion will elicit a hyperresonant note, except when associated congestion of the bases is present, in which case, impaired resonance or relative dullness is obtained over these areas. On auscultation the examiner will hear low-pitched, prolonged inspiration, accompanied by low-pitched, prolonged wheezy expiration. The rales heard will be large and small, moist and dry. A profusion of all kinds of rales is usually audible in this class of cases, though the rales may disappear temporarily after the secretion has been coughed up.

BRONCHIAL ASTHMA

General Considerations

Familial susceptibility, environmental exposure, and such modifying factors as psychogenic stimuli must all be considered in the etiologic evaluation of an allergic patient. Half of these patients give a definite history of family allergy (rhinitis, asthma, eczema, urticaria). Seventy-five per cent of children with 2 allergic parents will be allergic. A familial history gives no information, however, about the specific clinical expression of the allergy.

Most allergic disorders of the respiratory tract are caused by inhalant allergens, principally pollens (especially the ragweed family), animal danders, and housedusts.

Modifying factors (psychic stress infections, endocrine distur­bances) may precipitate symptoms by upsetting the "balance" between the patient and his allergenic environment. The antigen-antibody reaction then results, and leads to the rapid appearance of reversible tissue changes; increased capillary permeability, in­creased secretion of mucus, spasm of smooth muscle, and increased

numbers of eosinophils in the tissues, secretions and peripheral blood.

The onset of bronchial asthma is usually before 20 years of age.

Clinical Findings

A. Symptoms and signs: Bronchial asthma is characterized by
recurrent acute attacks of wheezing, dyspnea, cough, and expec­
toration of mucoid sputum (especially at the end of an attack).
Coughing at night, coughing and wheezing on exertion, and a
history of frequent "colds" may be more prominent in children
than clear-cut paroxysms of wheezing. Nasal symptoms (itching,
congestion, and watery discharge) may precede attacks of wheezing.

The acute attack presents a characteristic picture. The patient sits up, "fighting for air", with his chest fixed in the inspiratory position and using his accessory muscles of respiration. Great difficulty is evident with expiration. Wheezing may be audible across the room and usually overshadows other pulmonary signs.

When bronchial asthma becomes prolonged, with acute, severe, intractable symptoms, it is known as status asthmaticus.

B. Laboratory findings: The sputum is characteristically tena­
cious and mucoid, containing "plugs" and "spirals". Eosinophils are
seen microscopically.

C. X-ray findings: Chest films usually show no abnormalities.
Emphysema may be acute (reversible) in severe paroxysms or
chronic (irreversible) in long-standing cases. Transient, migratory
pulmonary infiltrations have been reported. Pneumothorax may
complicate severe attacks.

Complications. Chronic bronchial asthma may lead to such complications as chronic pulmonary emphysema and chronic cor pulmon