Introduction of infectious diseases 13

examination. At the inept approach to the patient and frivolous attitude to the epidemiological anamnesis obtaining, the doctor cannot get the necessary information. Sometimes it is difficult to take the correct anamnesis because in case of the disease with a long incubative period the patient and his relatives can forget some data, which are of the diagnostical and epidemiological value.

The following points are the most important for the epidemiological anamnesis:

1. Way of living and living conditions of the patient. It is necessary to explicitly find out whether the ambient situation could have promoted the intrusion of an infectious agent. If during the last three weeks before the onset of the disease the patient lived at the place of spreading of the infectious diseases, the patient can have developed a similar disease. The information about the cases of this or that infection in the patient's house confirms this idea even more. The use of unboiled water, milk, dirty fruit, pot herb, meat and fish products of poor quality can be a source of intestinal infection. The wounds, bruises, splinters are characteristic features of erypsipelas, tetanus, septic diseases.

2. The patient's occupation. Thus the workers of cattle-breeding farms can more often get sick with brucellosis, the agricultural workers r with leptospirosis, hemorrhagic fever, tick epidemic typhus, the workers of rice fields are subject to the infection of ankylostomidosis and strongyloidosis.

'3. The previous diseases and preventive vaccinations. This information is necessary as the previous diseases in a number of cases is evident against the disease which is suspected at this moment. However, it is always necessary to take into consideration that there is not a single infectious disease, which would not repeat, though in rare cases. Such diseases as flu, malaria, shigellosis, diphtheria, erypsipelas are the most recurring. And vice versa measles, epidemic typhus results in a strong and continuous immunity which guarantees from the recurrence of the diseases. Vaccination in anamnesis does not eliminate a possibility of the disease caused by the same infection, but there are often distorted, atypical forms of the disease, the so-called deleted forms in case of vaccination. Having taken the epidemiological anamnesis one starts to inquire about the main complaints and symptoms,paying attention to every detail in the sequence of their development.

The temperature rise is one of the earliest symptoms which gives ground to think of an infection when there are still no other clinical manifestations of the illness. The temperature which rises in the morning or in the evening up to 37 °Ñ usually is not considered normal. However, it is necessary to take into consideration the individual peculiarities of the patient, as for some patients the normal temperature limits are 37.0-37.3 °Ñ, and on the contrary for a number of patients the normal temperature does not rise above 36.2-36.3 °Ñ and a slightest rise even on some tenths of a degree already is evidence of abnormal temperature.

The temperature rise can be fast (acute), when the patient clearly marks even the hour of the onset of the disease (ornithosis, leptospirosis, etc.). In case

14 Infectious diseases

of the fast temperature rise, as a rule, the patient marks the chills of different grade - from slight chills up to severe chills (malaria). The temperature may rise gradually in other diseases (typhoid, paratyphoids).

According to the grade of the fever there are distinguished the following conditions: a subfebrile condition (37.0-37.9 °Ñ), a moderate fever (38.0-39.9 °Ñ), a high fever (40.0-40.9 °Ñ) and hyperpyrexia (41 °Ñ and higher). Taking into consideration the pathogenesis of the fever, the subfebrile condition should also be considered as a fever.

The nature of the temperature curve. In some infectious diseases the temperature curve is so characteristic that it determines the diagnosis (malaria, typhoid fever). It is accepted to determine several types of a temperature curve, which are of a diagnostic value.

The constant fever (febris continua) is characterized by the permanently high body temperature often up to 39 °Ñ and higher, the daily temperature fluctuations are less than 1°C and observed in typhoid-paratyphoid diseases, Q- fever, epidemic typhus, etc.

The remittent fever (/. remittens) is distinguished by daily fluctuations of the body temperature from more than 1°C but not more than 2 °Ñ (ornithosis, etc.).

The intermittent fever (/. intermittens) is manifested by the correct change of the high or very high and normal temperature with daily fluctuations of 3-4 °Ñ (malaria, etc.).

The relapsing fever (/. recurrens) is characterized by the correct change of the high-fever and fever-free periods that last several days (typhoid fever, etc.).

The undulating or undulant fever (/. undulans) is distinguished by a gradual increase of the temperature up to the high points and then its gradual decrease to the subfebrile and sometimes normal temperature; in 2-3 weeks the cycle is repeated (visceral leishmaniasis, brucellosis, lymphogranulomatosis).

The hectic (exhausting) fever (/. hectica) - a prolonged fever with considerable daily fluctuations (3-5°C) with the decrease to the normal or subnormal temperature (sepsis, generalized virus infection, etc.).

The irregular (atypical) fever (/. irregularis) is characterized by large daily amplitude, a various degree of a temperature increase, an indeterminate duration. It stands closer to the hectic fever, but does not have a regular rythm (sepsis, etc.).

The distorted (inverted) fever (/. inversa) is distinguished by a higher morning temperature than the evening one.

Besides these generally accepted types we consider expedient to mention two more: an acute undulating fever and a relapsing one.

The acute undulating fever (/. undulans acuta) in contrast to the undulate one is characterized by relatively short waves (3-5 days) and by the absence of remissions between the waves; the usual temperature curve represents a series of damped waves, i.e. each subsequent wave is less expressed (in the altitude

Date: 2014-12-21; view: 1168