Determination of salts deficit is based on laboratory information.

Acute intestinal infections in children mainly are accompanied by isotonic type of dehydration, that's why determination of blood electrolytes to all children with diarrhea is not necessary. Determination of Na+ and K+ is necessary at 3^rd degree of dehydration and for children with 2^nd degree of dehydration, in which general condition severity does not correspond the diarhea severity, anamnesis is complicated, a rapid effect from the rehydration therapy is absent.

A calculation of sodium and potassium deficit is done by the following formula:

Ion deficit = (normal ION concentration - patient's ION concentration) x M x C, where

M is weight of the patient

C is a coefficient of intracellular fluid volume.

C = 0.3 - before 1 year

C = 0.2 - after 1 year and for adults.

Than it is necessary to define the amount of sodium and potassium in solutions which

are entered, volume and correlations of which are already expected. A content of these

ions in solutions which are often used, are represented in a table.

After the urgent intravenous rehydration it is necessary to check up the level of sodium

and potassium in plasma. „,,,,

^{F p} Table 4

Content of ions in crystalloid solutions

Content of the ion in mmol/1 Osmolarity
SOLUTION	Na+	K+	Cl-	Ca++	Acetate (bicarbonate)	mosmol/1
Physiological solution		-		-	-
Ringer's solution					-
Ringer's lactate				1,5	28 (bicarbonate)
4 % NaHC03		-	-	-	500 (bicarbonate)
5 % dextrose solution on 0,45 % solution of NaCl		-	-	-	-

Taking into account importance of magnesium ions for the child's organism, and also that the magnesium losses go parallell with potassium losses on the first stage of rehydration therapy a 25 % solution of magnesium is rotined in the dose of 0,5-0,75 mmol/kg (1 ml of solution = 1 mmol of magnesium).

In children with a severe malnutrition daily necessity in potassium and magnesium is enlarged (up to 3-4 mmol potassium and 0.4-0.6 mmol magnesium).

c) Current pathological losses are determined by weighing of dry and wet diapers, determining the amount of the vomit or with a help of calculations:

10 ml/kg/day on every degree of temperature over 37.0 °C;

20 ml/kg/day in case of vomiting;

20-40 ml/kg/day in case of intestinal paresis;

25-75 ml/kg/day in case of diarhea;

30 ml/kg/day for perspiration. Control of correct rehydration therapy is frequency of pulse, frequency of breathing, dynamics of body weight and diuresis.

Rehydration therapy depending the type of dehydration

It is necessary to take into account the type of dehydration to choice solutions and their correlations for the rehydration therapy. There are 3 types of dehydration: isotonic, hypertonic (water deficient) and hypotonic (salt deficient) (Table 5).

Table 5

Signs of different forms of dehydration

Index	Isotonic type of dehydration	Hypotonic type of dehydration „	Hypertonic type of dehydration
Breathing	No peculiarities	Hypoventilation	Hyperventilation
Blood pressure	Decreased or increased	Low	Remains normal for a long time
Temperature of the body	Subfebrile	Normal, tendency to the hypothermia	Febrile
Skin	Cold, dry, elasticity is decreased	Cold with a cyanotic tint, elasticity is decreased	Elasticity is stored, warm
Nervous system	Malaise	Excitation, possible cramps	Disturbance, sleeplessness
Diuresis	Diminished	Diminished	For long time it remains normal
Specific gravity of the urine	Normal or insignificantly encreased	Decreased to 1010 or low	Increased to 1035 and more
Osmolality of plasma	Normal	Decreased	Increased
A level of electrolytes in the blood	Normal	Low	Increased

An isotonic rehydration (Na 130-150 mmol/1) develops as a result of equal losses of salts and water; it is the most often type of dehydration in children with an acute intestinal infection. In the first days (in case of microcirculation maintenance) rehydration is performed by 5 % glucose solution in combination with 0.9 % sodium chloride or Ringer's lactate solution in correlation (2:1) with parallel correction of electrolytes.

Next days of rehydration therapy glucose-saline solutions in a volume which provides the physiologic fluid's requirement of organism, remnant volume for the compensation of dehydration, current pathological losses, correction of plasma electrolytes are performed.

Hypertonic dehydration (Na > 150 mmol/1) develops as a result of fluid losses predominance above salts loses, inadequate rapid infusion of salts with small amount of water.

Rehydration therapy should be done by a 5 % glucose solution in combination with 0.9 % sodium chloride solution in correlation (3:1).

During the rehydration therapy for patients with hypertonic dehydration it is need to take into account daily sodium requirements (2-3 mmol/kg). Thus should be taken into account sodium in solutions for infusion.

If the level of sodium is 140-150 mmol/1, then amount of sodium should be decreased 2 times from physiology necessities, and at the increase of it more than 150 mmol/1 solutions which contain sodium are eliminated, except colloid ones.

It is necessary to investigate a potassium level and correct it if it is needed.

To prevent cerebral edema control of plasma osmolarity and body weight is needed. On this stage a speed of infusion is 15-20 drops per hour.

Hypotonic dehydration (Na < 130 mmol/1) develops as a result of salts losses predominance above fluid loses, excessive infusion of water with small amount of salts. It developes in case of intestinal infections which are accompanied by frequent vomiting, or during oral rehydration by solutions with small amount of salts.

Rehydration therapy is done by 5 % glucose solution in combination with 0.9 % sodium chloride in correlation (1:1).

If the level of sodium is less than 129 mmol/1 it is needed to correct it (calculate it by formula described before). During the correction of sodium hypertonic solutions are avoided. Their infusion can result in acute intracellular dehydration, first of all cerebral. Except this, anaphylactic reactions can develop. The correction of sodium is done by 0.9 % NaCl, Ringer's lactate.

If it is impossible to investigate blood electrolytes, glucose-saline solutions are infused in correlation 1:1.

By the WHO recommendations (if the fast rehydration is necessary in case of laboratory control absence) the volume and speed of 0.9 % NaCl, Ringer's lactate infusion on the first rehydration stage should be the following (Table 6):

Table 6

Speed of infusion during the rehydration therapy

Age of the child	Speed of infusion	Speed of infusion
Before 12 months	30 ml/kg for the first 1 hour	70 ml/kg for the next 5 hours
Elder than 12 months	30 ml/kg for the first 30 minutes	70 ml/kg for the next 2.5 hours

The condition of the child is checked up each 15-30 minutes to normal pulse filling on a radial artery. If the condition of child does not get better, speed of infusion should be increased. After that the condition of the child is estimated every hour (abdominal skin fold, consciousness, possibility to drink).

After all volume is entered the child's condition should be estimated again:

• if the signs of severe dehydration still present - repeat infusion again according the

table 6.

• if the child's condition gets better, but there are signs of moderate dehydration -

continue oral rehydration according the table 2. If a child is breast fed, it is recommended to continue feeding; numbers of feeding should be increased.

• if signs of dehydration are absent, then the duration of feeding should be increased. At the same time at presence of diarrhea for su pporting rehydration 50-100 ml of oral rehydration solution is given to the children aged before 2 yrs, 100-200 ml to the children elder than 2 yrs or 10 ml/kg additionally after every emptying (up to 1/3 expected volume for oral rehydration). Children on the artificial feeding are fed by the same chart, by lactose free formulas. Monitoring of children with a severe malnutrition and dehydration during the rehydration therapy should be done each 30 minutes during the first 2 hours, and then every hour next 4-10 hours. At signs of hyperhydratation (increase of pulse frequency on 15 per minute, breathing frequency on 5 per minute) rehydration should be stopped. Than estimate the child's condition through an hour.

During parenteral rehydration for such children, and also for children with pneumonia, toxic encephalopathy, speed of fluid infusion must not exceed 15 ml/kg/hour. At these states daily body weight gain in the first 3 days must not exceed 1-3 %.

In case if dehydration is absent and infectious toxic shock is developed reanimation measures according the protocol should be done.

2. Antibacterial therapy

Antibacterial therapy at invasive diarrhea is given to:

1. Children with severe and moderate forms of disease.

2. Children aged before 3 months independent of the disease severity.

3. Children with the immune deficiency, HIV-infected children, children, that receive immune suppressive therapy (chemical, irradiation), long corticosteroid therapy, children with hemolytic anemia, hemoglobinopathies independent of age and the disease severity.

4. Children with hemocolitis independent of age and the disease severity.

5. Children with the secondary bacterial complications in all age groups.
Antibacterial therapy at secretory diarrhea is given to:

1. Children with severe and moderate forms aged before 6 months.

2. Children with the immune deficiency, HIV-infected children, children, that receive immune suppressive therapy (chemical, irradiation), long corticosteroid therapy, children with hemolytic anemia, hemoglobinopathies.

3. Cholera, parasitogenic diarrhea independent of age and the disease severity.

4. Children with the secondary bacterial complications in all age groups.
Antibacterial therapy is not indicated to:

1. Children with mild, effaced and moderate forms of infections, except for those which are listed above.

2. Children bacillus carriers of any etiology (transitory, postinfectional).

3. Children with alimentary dysfunction, as a result of an acute intestinal infection (intestine dysbiosis, lactase insufficiency, celiac syndrome, secondary enzymopathy etc.).

Antibacterial therapy if the etiology of an acute intestinal infection is known:

Table 8

Antibacterial preparations which are recommended for treatment of an acute intestinal infections for children at the known exciter of illness

Acute intestinal infection etiology	Starting preparation	Preparation of reserve
Shigella	Ciprofloxacin* Nifuroxazid	Ceftriaxone Trimetoprim/sulfamethoxazolum Azithromycin
Salmonella	Ceftriaxone Cefotaxime Nifuroxazide	Trimetoprim/sulfamethoxazolum Ciprofloxacin Ampicillin** Chloramphenicol** Azithromycin
Enterotoxigenic E.coli	Trimetoprim/sulfamethoxazolum Doxycyclin (to the children elder than 8 years)	Aminoglycosides** Nifuroxazide
Entheroinvasive E.coli***	Nifuroxazide Ciprofloxacin	Trim etoprim/ sulfamethoxazolum Ceftriaxone Azithromycin
Kampylobacter	Erythromycin Ciprofloxacin	Aminoglycosides* * Amoxicillin/clavulanat Carbapenems (imipenem, carbapenem)
Yersinia enterocolitica	Ceftriaxone Cefotaxime Ciprofloxacin	Trimetoprim/sulfamethoxazolum Doxycycline (to the children elder than 8 years) Aminoglycosides** Chloramphenicol* *
Vibrio cholerae	Trimetoprim/sulfamethoxazolum Doxycycline (to the children elder than 8 years)	Nifuroxazide Furazolidonum Ciprofloxacin
Clostridium deficite	Metronidazole	Ornidazole Vancomycin (through a mouth)
Giardia Lamblia	Metronidazole Furazolidonum	Ornidazole
Amoeba hystolitica	Metronidazole Intetrix	Tinidazole

* - other fluorquinolons, except Ciprofloxacin, are not recommended to the children.

** - only in case of sensitivity to the antibiotic.

*** - in case of Entherohemorrhagic E.coli antibiotics can provoke hemolytic-uremic syndrome.

It is recommended to prescribe for empiric therapy of an acute intestinal infection (in case of the unknown etiology): Nifuroxazide,Trimetoprim/sulfamethoxazolum, Cefotaxime, Ceftriaxone, Ciprofloxacin.

At a necessity of empiric antibacterial therapv of secretory diarrhea cefalosporins of 3^rd-4^th generations are used.

Aminoglycosides (IM, IV)	Gentamycin 2-3 mg/kg/day Amikacin 15 mg/kg/day Netylmycin: children before 1 year 7,5-9 mg/kg children elder 1 year - 6-7,5 mg/kg Course of treatment 5-7 days	2 times per day 2-3 times per day 3 times per day 3 times per day
Furazolidonum (through a mouth)	8-10 mg/kg daily dose Course of treatment 10 days	4 times per day
Doxycyclin (through a mouth) to children elder than 8yrs	Children aged 9-12 years daily dose - the first day 4 mg/kg, then 2 mg/kg Course of treatment 7-10 days	2 times per day
Vancomycinum (through a mouth)	40 mg/kg daily dose Course of treatment 7-10 days	3-4 times per day
Chloramphenicol	Through a mouth children before 3 yrs - 10-15 mg/kg children aged 4-8 years - 0,15-0,2 g children elder than 8 yrs - 0,2-0,3 g IM children before 1 year daily dose 25-30 mg/kg children elder 1 year daily dose - 50 mg/kg Course of treatment 5-10 days	3-4 times per day 30 min before the meal 2-3 injections
Metronidazole (through a mouth)	Amebiasis: children aged 2-5 years - 0,25 g children aged 6-10 years - 0,375g children aged 11-15 years - 0,5g Course of treatment 10 days Giardiasis: children aged 2-5 years - 0,2 g children aged 6-10 years - 0,3 g children aged 11-15 years - 0,4g Course of treatment 5-7 days	Once a day during a meal
Ornidazole (through a mouth)	Giardiasis - 40 mg/kg Course of treatment 1-3 days Amebiasis - 25-30 mg/kg Course of treatment 1-3 days	Once a day
Albendazole (through a mouth)	Giardiasis children elder 2 yrs 400 mg Course of treatment 5 days	Once a day
Tinidazole (through a mouth)	Amebiasis - 30 mg/kg Course of treatment 3 days	Once a day
Intetrix (through a mouth)	Children after 12 years - 1 capsule Course of treatment 10 days	4 times per day
Carbapenems	Imipenem/cilastatin (IM, IV) children with body weight less than 40 kg - 15 mg/kg (maximal daily dose is 2 g) children with body weight more than 40 kg - 500- 1000 mg maximal daily dose is 2 g) Meropenem (IV) 10-12 mg/kg children with body weight more than 50 kg - 500 mg Course of treatment according the evidences	4 times per day 2-4 times per day 3 times per day

Diet

An important moment in organization of sick children feeding is a waiver of water-tea pauses, as it is well-proven that even at the severe forms of diarrhea the digestive function of greater part of intestine is saved, and pauses will decelerate reparation processes, reduce intestine tolerance to the meal, and considerably weaken immunity of organism. A volume and composition of meal depends from child's age, weight and severity of diarrhea, character of previous diseases. Rational feeding is important for rapid renewal of the intestinal function.

In the acute period of gastroenteritis it is recommended to diminish daily volume of meal on 1/2-1/3, in the acute period of colitis - on 1/2-1/4. Possibly increase of feedings up to 8-10 times per day for infants, especially at urges to vomit. In this time most physiologic is early, but gradual renewal of feed. Proceeding in high-quality and quantitative composition of meal is characteristic for this age of child, carried out in short period after the rehydration and disappearance of dehydration (4-5 days). In this period it is recommended diet for every day. The fat, fried, smoked food and others like that are eliminated from a ration in elder children.

If a child is breast fed, it is recommended to continue feeding.

Products with high amount of lactose should be eliminated (milk formulas, milk, fruit juices). This will decrease secretory diarrhea duration. Children on the artificial feeding are fed by the same chart, by lactose free formulas. Lactose free diet should last individually from 1-4 weeks to 1.5-2 months. Porridges prepared on water are recommended, meet puree should be given earlier. Diary milk formulas after 8 month are recommended.

Soya containing formulas are not recommended because intestine excessive sensitivity to soy proteins in diarrhea. It is risky for protein entheropathy development. Apple prepared in the oven, bananas, apple and carrot puree contain large amount of pectins are recommended in case of colitis.

Auxiliary therapy of an acute intestinal infection

Probiotics can be applied as independent etiotropic treatment (in cases when antibacterial therapy is not indicated) or as additional medicine during antibacterial therapy. Probiotics, which contain lacto-, bifidobacteria and propinebacteria. Self eliminate probiotics (contain saccharomycets) or probiotics which contain lactobacteria are used in invasive diarrhea on a background of antibacterial therapy. The last ones are stable to antibiotics.

To the children with the immunodeficiency, those which are treated in the intensive care units probiotics aren't appointed.

The course of therapy lasts for 5-10 days.

Enterosorbents

Enterosorbents are able to fix on their surface hundreds of millions bacteria. Fixed microbes are ruined and eliminated from a sick organism. Together with the bacteria enerosorbents fix on their surface rotaviruses from the intestine. Except for the infectants enerosorption destroy the toxins of microbes and products of their metabolism. They transform toxic matters in less toxic.

The most perspective at treatment of an acute intestinal infection in children are "white", alumsilicate enerosorbents. Unlike coal sorbents they do not require introduction of high

dose of preparation for achievement of therapeutic effect. Also coal sorbents get to the submucous layer of the intestine and can damage it.

In obedience to WHO recommendations (2006) in auxiliary therapy of an acute intestinal infection are recommended preparations of zinc (to the children before 6 months - 10 mg per day, children elder than 6 months - 20 mg per day during 10-14 days).

Prophylaxis:

- Epidemiological control.

- Isolation and sanation of ill person and carriers.

- Reconvalescent may be discharged from hospital after one negative feces culture (taken 2 days after stop of antibiotic therapy).

- Dispensarization of reconvalescents for 3 months.

- Feces culture in contacts, carriers.

- Observation of contacts for 7 days without quarantine.

- Disinfection in epidemic focus.

Kev words and phrases: nosocomeal salmonellosis, gastrointestinal form, carrying.

Tests and assignments for self assessment Multiple choices. Choose the correct answer/statement:

1. What form of salmonellosis more often occurs in newborns?

A. Gastrointestinal (gastritis)

B. Gastrointestinal (gastroenteritis)

C. Gastrointestinal (enterocolitis)

D. Septic

E. Typhoid

2. Main signs of salmonellosis are:

A. Respiratory syndrome B.Rash

C. Hyperthermia

D. Disuria

E. Dyspepsia

3. Typhoid form of salmonellosis is not characterized by:

A. Hectic fever

B. Toxic syndrome

C. Roseols on skin

D. Osteomyelitis

E. Dyspepsia

4. Septic form of salmonellosis is not characterized by:

A. Hepatosplenomegaly

B. Toxic syndrome

C. Roseols on skin

D. Osteomyelitis

E. Dyspepsia

5. In typical cases of salmonellosis stools are:

A. Liquid, green, without mucus

B. Liquid with nondigested parts of food

C. Liquid, green with mucus, muddy

D. A small amount with mucus, blood, like spit

E. Liquid, dark-yellow with large amount of water

6. Name the main laboratory test to prove salmonellosis:

A. Blood analysis

B. Bacteriological (fecal culture)

C. Koprogram

D. Serological

E. Bacteriological (blood culture)

7. What etiological treatment should be used in mild cases of salmonellosis?

A. Furazolidone

B. Enzymes

C. Cephalosporins

D. Rehydrates

E. Bacteriophage

8. What etiological treatment should be used in severe cases of salmonellosis?

A. Furazolidone

B. Enzymes

C. Cephalosporins

D. Rehydrates

E. Bacteriophage

9. What diseases must be hospital salmonellosis mainly differentiated from?

A. Escherichiosis

B. Viral diarrhea

C. Intestinal intussusception

D. Staphylococcal diarrhea

E. Dysentery

10. What dose of fluorquinolones is used to treat severe cases of salmonellosis?

A. 10-20 rag/kg per day

B. 40-50 mg/kg per day

C. 50-100 mg/kg per day

D. 150 mg/kg per day

E. 200 mg/kg per day

Algorithm of practical students' work

Complaints and anamnesis taking in newborns and infants

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Tactful and calm conversation with the parents of sick child.

5. Explanation of future steps concerning the child (hospitalization, some methods of examination, etc.).

Complaints and anamnesis taking in toddlers and preschoolers (children aged from 1 to 6 years)

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. By means of game playing find a contact with a child.

5. Tactful and calm conversation with the parents of sick child.

6. Explanation of future steps concerning the child (hospitalization, some methods of examination, etc.).

Complaints and anamnesis taking in school age children

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Tactful and calm conversation with sick child his/her parents.

5. Explanation of further steps to child and his/her parents (hospitalization, some methods of examination, etc.).

1. To collect complaints:

• fever, poor appetite, anxiety, fatigue, cramps;

• nausea, vomiting, diarrhea with pathological admixtures: green, mucus, blood;

• weight loss.

2. To collect anamnesis of the disease, epidemiological anamnesis

• Acute beginning of the disease from fever, toxic syndrome, pain, dyspepsia, joining and

progress of dehydration.

• Eating of the infected products, contact with a patient who had diarrhea 2-7 days prior to

the disease beginning.

• There are alike signs in surrounders, which ate the same products.

• Treatment in somatic, surgical, infectious departments 5-10 days prior to the disease,

where the cases of hospital salmonellosis are registered.

• Conversation accomplishment.

3. To inspect a patient:

Physical methods of examination of newborns and infants

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to the parents what examination should be performed and obtain there informed consent.

5. Prepare for examination(clean and warm hands, warm phonendoscope, etc.).

Physical methods of examination of toddlers and preschoolers

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to the parents what examination should be performed and obtain there informed consent.

5. Find a contact with a child; try to gain his/her confidence.

6. Prepare for examination (clean and warm hands, warm phonendoscope, etc.).
Physical methods of examination of school age children

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to the parents what examination should be performed and obtain there informed consent.

5. Find a contact with a child; try to gain bis/her confidence.

6. Prepare for examination (clean and warm hands, warm phonendoscope, use the screen if necessary etc.).

A. Examination:

• a skin is dry, pale, sunken eyes, acute lines of the face;

• dry and bright mucus membranes, coated tongue;

• metheorism, or sunken abdomen.

B. Palpation:

• lowering of skin elasticity, soft tissues turgor, sunken big fontanel, weight deficit;

• tender abdomen, spasm of sigmoid colon, grumbling of thin intestine, hepatomegaly,

splenomegaly.

C. Auscultation:

• increased intestinal murmurs;

• tachycardia, strengthening, or deafness of cardiac tones;

• tachypnea, harsh breathing. Conversation accomplishment. Informing about the results of examination

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to a child and his/her parents what examinations should be performed and obtain their informed consent.

5. Involve adolescent and his/her relatives in to the conversation (compare present examination results with previous ones, clarify whether your expectations are clear for them or not).

6. Conversation accomplishment.

4. To estimate the results of additional researches

• Complete blood analysis: leucocytosis, neutrophilia with a shift to the left, Ieucopenia,

lymphocytosis, ESR acceleration.

• Biochemical blood test: increased, normal or decreased concentration of electrolytes.

• Koprogram: inflammatory changes, intestinal enzymopathy.

• Fecal culture: Salmonella selection.

• Serology: IHAR, AR with specific test system, growth of antibodies titre in dynamics.

• Explaining the results of examination to child's parents.

• Conversation accomplishment.

5. To substantiate the diagnosis.

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to child's parents the necessity of further treatment directions correctly and accessibly.

5. Discuss with parents and their child the peculiarities of drug intake, duration of usage, side effects and find out whether they understand your explanations.

6. Conversation accomplishment.

6. To prescribe the treatment: regime, diet, antibiotics, probiotics, rehydration therapy, correction of electrolytes; enzymes, detoxication, symptomatic medicine. Informing about treatment prognosis

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Correct and clear explanation of expected results of treatment.

5. Discuss with the parents and their child the importance of continuous treatment, following the treatment scheme; make sure that your explanations are properly understood.

6. Conversation accomplishment.

Step

1. The child, 10 days old, has entered to the infectious department with mother's complaints on
increasing of the temperature to 38.7 °C, repeated vomiting, porridge-consistence feces with green
mucus to 5 times per day. There were some episodes of Salmonellosis in the maternal house. The
heart tones are dull, 146 per minute. The abdomen is distended; the liver emerges from the rib on 3
cm, spleen - on 1 cm. In 3 days in the child was diagnosed purulent arthritis. What is the most
possible diagnosis?

A. Salmonellosis, gastrointestinal form

B. Salmonellosis, typhoid form

C. Salmonellosis, septic form

D. Salmonellosis, influenza-like form

E. Salmonellosis, dysentery-like form

2. The boy, 4 years old, complains of abdominal pain, repeated vomiting, increased frequency of defecation, fluid feces, high body temperature - 38 °C. He is ill for 4 days. Because of severe condition (the appearing of blood in feces) he entered to infectious department. What investigation will confirm the diagnosis?

A. Bacteriological examination of the feces on dysentery, typhoid, paratyphoid fever

B. General blood test

C. Bacteriological examination of cerebrospinal fluid

D. Thick smear of the blood

E. Bacteriological investigation of pharyngeal swab

3. A girl, 7 years old, complains of periodic colicky abdominal pains, increased frequency of defecation, temperature 39.2 °C. During objective examination a painful sigmoid colon is revealed. Feces are dark-green in a small amount, with much mucus. Anus is closed. During feces bacteriological examination was found Salmonella enteritidis. What disease must be differentiated from this form of salmonellosis?

A. Shigellosis

B. Typhoid fever

C. Escherichiosis

D. Acute appendicitis

E. Staphylococcal enterocolitis

Real-life situation to be solved:

1. A child, 2 years old, is treated in the infectious department for 4 days because of salmonellosis, gastrointestinal form, moderate severity.

1. What clinical features of the disease are typical in this case?

2. When the patient can be discharged from the department?

3. Name prevention in the epidemic focus.

2. A boy, 8 months old, has entered the infectious department. His disease had acute beginning. Now: doesn't want to drink anything; repeated vomiting, body temperature is 35.5 °C. Objectively: skin pallor, with "marble" paint, skin and mucus membranes are dry; large fontanel is lower than skull bones; cold extremities; tachycardia, tenderness of abdomen in the left inguinal area. Feces are in a large amount, looks like mud, with mucus. In entrance room he became consciousless, tonic-clonic seizures has appeared. Body weight is 8 kg.

1. What type of dehydration has developed?

2. Account daily amount of fluids to this child for rehydration. How many saline and water fluids must be given?

Дата добавления: 2015-11-14