INTESTINAL INFECTIONSINTESTINAL INFECTIONS

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

General CharacteristicsGeneral Characteristics

The key role of intestinal infection in The key role of intestinal infection in human health and socioeconomic human health and socioeconomic

system is determined by the epidemic system is determined by the epidemic patterns of occurrence and the high patterns of occurrence and the high morbidity rate, specific for some of morbidity rate, specific for some of

them, such as Shigellosis, Salmonellosis them, such as Shigellosis, Salmonellosis and Viral hepatitis A. The infant and Viral hepatitis A. The infant

mortality rate is highly affected by mortality rate is highly affected by nosocomial infections, such as E.coli nosocomial infections, such as E.coli

enteritis and Salmonellosis, with enteritis and Salmonellosis, with increased lethality among infantincreased lethality among infant..

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

infectionsinfectionsIntestinal infections are characterized by Intestinal infections are characterized by

great etiologic variety. They are great etiologic variety. They are caused by intestinal bacteria of the caused by intestinal bacteria of the Enterobacteriaceae family /genera Enterobacteriaceae family /genera

Esherichia, Shigella and Salmonella/, Esherichia, Shigella and Salmonella/, genera Vibrio, Leptospira, by genera Vibrio, Leptospira, by

conditionally pathogenic bacteria of conditionally pathogenic bacteria of the genera Proteus, Enterobacter, the genera Proteus, Enterobacter,

Klebsiella, Staphylococcus, Brucella, Klebsiella, Staphylococcus, Brucella, Pseudomonas aeroginosa, Clostridium Pseudomonas aeroginosa, Clostridium

and viruses.and viruses.

These infections have fecal-oral These infections have fecal-oral transmission mechanism, transmission mechanism,

realized via multiple routes of realized via multiple routes of spread and resulting in the spread and resulting in the occurrence of water, food, occurrence of water, food,

contact and nosocomial contact and nosocomial epidemics and epidemic epidemics and epidemic

outbreaks.outbreaks.

Water epidemicsWater epidemics

They are caused by three main factors:They are caused by three main factors:- Contamination of drinking water Contamination of drinking water

resourcesresources- Technical failures and breakdown of Technical failures and breakdown of

water supply and sanitation water supply and sanitation installations and distribution installations and distribution systemssystems

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

Food epidemicsFood epidemics

They refer to primary /during They refer to primary /during animal,s lifetime/ and secondary animal,s lifetime/ and secondary

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

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

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

and vegetables.and vegetables.

Contact epidemicsContact epidemics

They refer to habits/conditions of They refer to habits/conditions of life, associated with poor life, associated with poor

hygiene, such as contaminated hygiene, such as contaminated hands, insects/flies, toys. hands, insects/flies, toys.

Additionally, classical intestinal Additionally, classical intestinal infections occur as nosocomial infections occur as nosocomial

infections.infections.

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

dysfunction and disturbed dysfunction and disturbed motility of the upper motility of the upper

gastrointnstinal tract are shared gastrointnstinal tract are shared characteristics in the characteristics in the

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

Patients age and related individually Patients age and related individually specific immunogenesis are the specific immunogenesis are the predisposing factors for a more predisposing factors for a more

severe clinical course of the intestinal severe clinical course of the intestinal infections. In addition, specific infections. In addition, specific

nutrient intake pattern, the type, nutrient intake pattern, the type, resistance-marker, toxigenicity, resistance-marker, toxigenicity,

pathogenicity and degree of invasion pathogenicity and degree of invasion of the causative agent play an of the causative agent play an

important role in disease progression.important role in disease progression.

There is general susceptibility to There is general susceptibility to intestinal infections causative agents. intestinal infections causative agents. Postnatal immunity increases with the Postnatal immunity increases with the

age, while the immunity, acquired age, while the immunity, acquired after the illness is stable and after the illness is stable and

continuous for only some of the continuous for only some of the intenstinal infections, such as intenstinal infections, such as

Abdominal typhus, Salmonellosis, Abdominal typhus, Salmonellosis, E.coli enteritis and Poliomyelitis. The E.coli enteritis and Poliomyelitis. The

acquired immunity is also type-acquired immunity is also type-specific, thus, making the specific specific, thus, making the specific

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

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

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

Anti-epidemic activities and measuresAnti-epidemic activities and measures

They include:They include:

- Immediate epidemiologic research in - Immediate epidemiologic research in the focus of infection diseasethe focus of infection disease

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

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

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

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

Prophylactic and anti-epidemic Prophylactic and anti-epidemic measuresmeasures

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

- Source of infectionSource of infection- Mechanism of transmissionMechanism of transmission- Susceptibility of the Susceptibility of the

populationpopulation

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

environment reflect on the environment reflect on the intensity of the epidemic process. intensity of the epidemic process. Thus the efficacious prophylactics Thus the efficacious prophylactics

and effective fight against inf. and effective fight against inf. diseases are possible only when diseases are possible only when the antiepidemic measures are the antiepidemic measures are

directed in three ways: directed in three ways:

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

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

- Measures stimulating Measures stimulating insusceptibility of the insusceptibility of the population to a certain population to a certain diseasesdiseases

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

infectioninfection

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

-- Measures for derattization – used Measures for derattization – used at rodents, reservoirs of infectionsat rodents, reservoirs of infections

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

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

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

It this case the aim is to It this case the aim is to decontaminate the source of decontaminate the source of infection putting it in such infection putting it in such

conditions in which the conditions in which the possibilities for transmission possibilities for transmission

of infection care cut off.of infection care cut off.

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

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

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

chronic forms.chronic forms.

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

on:on:- Living conditions- conditions Living conditions- conditions

facilitating transmission of infection facilitating transmission of infection to other person should be eliminatedto other person should be eliminated

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

-- Possibilities for specific, Possibilities for specific, etiologic treatment of the etiologic treatment of the sick persons and carriers of sick persons and carriers of infectioninfection

Urgent prevention is also one of Urgent prevention is also one of the measures for influencing the the measures for influencing the source of infection. It is the use source of infection. It is the use

of prophylactic and creative of prophylactic and creative means to prevent development means to prevent development of the disease from the carriers of the disease from the carriers of infection in incubation. For of infection in incubation. For this purpose immune serums, this purpose immune serums,

vaccines, bioproducts, etc.vaccines, bioproducts, etc.

Measures stopping the mechanism Measures stopping the mechanism of transmission of infectionof transmission of infection

This measures are various This measures are various ones. They are mainly related ones. They are mainly related to the specific characteristics to the specific characteristics

of the mechanism of of the mechanism of transmission of the different transmission of the different inf. Diseases. Generally, it is inf. Diseases. Generally, it is very difficult to carryout such very difficult to carryout such

measures.measures.

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

The measures require the The measures require the agents of infection in the agents of infection in the faeces of the sick persons faeces of the sick persons

not to get trough food, water not to get trough food, water into the gastrointenstinal into the gastrointenstinal

tract of the healthy people.tract of the healthy people.

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

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

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

waterswaters

- Collection and Collection and decontamination of the hard decontamination of the hard wasteswastes

- Sanitary measures in public Sanitary measures in public cateringcatering

- Following the regulations of Following the regulations of sanitationsanitation

- School hygieneSchool hygiene

Diseases belonging of the group Diseases belonging of the group of respiratory infectionsof respiratory infections

Gauze masks, aeration and Gauze masks, aeration and ventilation, bactericidial ventilation, bactericidial

lamps, disinfection lamps, disinfection

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

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

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

health knowledgehealth knowledge

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

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

- DisinfectionDisinfection- Hygienic measures for Hygienic measures for

decontaminationdecontamination- Stimulating the accumulation of Stimulating the accumulation of

health knowledge of the health knowledge of the populationpopulation

Measures stimulating Measures stimulating insusceptibility of the populationinsusceptibility of the population

A perspective for prevention A perspective for prevention and fight against inf. and fight against inf.

diseases is development of diseases is development of specific insusceptibility of specific insusceptibility of

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

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

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

and immune tolerability.and immune tolerability.

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

which morphologic base is which morphologic base is proliferation and proliferation and

differentiation of the differentiation of the immunocompetent cells.immunocompetent cells.

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

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

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

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

competence through the competence through the “Fabricius bursa” (for the “Fabricius bursa” (for the

birds) or through its birds) or through its equivalent for the mammals, equivalent for the mammals,

probably bone marrow or probably bone marrow or part of the lymph tissue of part of the lymph tissue of

the intenstines- Payer,s the intenstines- Payer,s plaques, appendix and tonsilsplaques, appendix and tonsils

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

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

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

represents a state of represents a state of insusceptibility of the organism insusceptibility of the organism related to the species to which related to the species to which the man or the animal belong.the man or the animal belong.

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

development of the individual. development of the individual. The ability of the organism to The ability of the organism to

develop ontogenetic mechanism develop ontogenetic mechanism is a result from its phylogenesis. is a result from its phylogenesis. Individually immunity is divided Individually immunity is divided

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

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

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

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

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

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

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

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

immunity is related to the immunity is related to the way of development as well way of development as well as the level of its intensity as the level of its intensity

and duration.and duration.

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

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

> Humoral immunity- it acts > Humoral immunity- it acts trough B-lymphocytes as well as trough B-lymphocytes as well as antibodies circulating freely as antibodies circulating freely as immunoglobulins in the blood immunoglobulins in the blood and the other body liquids. and the other body liquids.

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

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

depending on its conditions.depending on its conditions.

> Cell immunity- it acts trough the > Cell immunity- it acts trough the circulating T-lymphocytes together circulating T-lymphocytes together

with the non-immunoglobulin with the non-immunoglobulin mediators of the lymph function mediators of the lymph function

( activated macrophages)( activated macrophages)

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

mediated- in the mediated- in the immunosecretory system of immunosecretory system of

the mucous of the the mucous of the gastrointestinal tract and gastrointestinal tract and

respiratory ways (the respiratory ways (the entrance of infection).entrance of infection).

Collective immunity- it is the ability Collective immunity- it is the ability of the human collective to resist to of the human collective to resist to

the activity of the agents of the the activity of the agents of the inf. diseases and to prevalence of inf. diseases and to prevalence of

the epidemic process. It is the epidemic process. It is determined by the specific immune determined by the specific immune structure of the population as well structure of the population as well as the possibility for realization of as the possibility for realization of the mechanism of transmission in the mechanism of transmission in

the real circumstances.the real circumstances.

Non-specific immunologic Non-specific immunologic structure – it characterized structure – it characterized

the degree of insusceptibility the degree of insusceptibility of the population to all inf. of the population to all inf. diseases. It is measured by diseases. It is measured by

different immunologic, different immunologic, physiologic and other physiologic and other

methods.methods.

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

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

Individuals immigrating to regions Individuals immigrating to regions which are endemic for certain which are endemic for certain diseasesdiseases

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

Characteristics of the three directions of Characteristics of the three directions of prevention and fight against inf. prevention and fight against inf.

diseases provide the possibility for diseases provide the possibility for achieving the necessary practical results achieving the necessary practical results

at many inf. diseases if the measures at many inf. diseases if the measures influencing the preventive directions are influencing the preventive directions are

simultaneously carried out- simultaneously carried out- decontamination of the source of decontamination of the source of

infection, stopping the mechanism of infection, stopping the mechanism of transmission and stimulating the specific transmission and stimulating the specific

insusceptibility of the population. insusceptibility of the population.

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

Measures to the patient:Measures to the patient:

>Early finding and recognition of >Early finding and recognition of the diseasethe disease

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

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

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

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

- Registration book of hospital Registration book of hospital infections- form infections- form №11№11 of Ministry of Ministry of healthof health

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

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

- Sanitary manipulation- bathing, Sanitary manipulation- bathing, decontamination of the clothes decontamination of the clothes and underwearand underwear

- Specific etiologic therapySpecific etiologic therapy- Dehospitalization of the patients:Dehospitalization of the patients:

. After full clinical recovery. After full clinical recovery

. Elimination of the pathogenic agent. Elimination of the pathogenic agent

. Disinfection of the clothes, . Disinfection of the clothes, underwearunderwear

Chronically sick patients are under Chronically sick patients are under dispansary observation.dispansary observation.

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

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

for finding of all contacting for finding of all contacting personspersons

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

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

Sanitary manipulation- when Sanitary manipulation- when necessarynecessary

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

Active or passive Active or passive immunizationimmunization

Urgent prevention with Urgent prevention with antibiotics and antibiotics and chemotherapeutical agentschemotherapeutical agents

Measures to the carriers of Measures to the carriers of infection:infection:

Finding- epidemiological Finding- epidemiological investigation, microbiological investigation, microbiological investigationinvestigation

Sanitation – directed to Sanitation – directed to elimination and cleaning of the elimination and cleaning of the pathogenic microorganismspathogenic microorganisms

IsolationIsolation

Specific preventionSpecific prevention

Definition: An approach for Definition: An approach for development of non-natural development of non-natural specific insusceptibility to specific insusceptibility to

the etiologic agent of a the etiologic agent of a certain inf. diseases.certain inf. diseases.

Vaccination process: An Vaccination process: An interaction between the interaction between the

vaccine agent and the human vaccine agent and the human organism with its individual organism with its individual

characteristics. It is a characteristics. It is a complex reaction, which complex reaction, which

includes a follows:includes a follows:

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

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

Different preparations are Different preparations are used for development of used for development of

immunity- vaccines, immunity- vaccines, toxoides, serums, toxoides, serums, immunoglobulins.immunoglobulins.

Live vaccinesLive vaccines

Immune preparations, containing Immune preparations, containing bacteria and viruses that have bacteria and viruses that have

lost their immunologic lost their immunologic properties. Such types of properties. Such types of

vaccines are as follows: against vaccines are as follows: against Tuberculosis, Polyomielitis ( oral Tuberculosis, Polyomielitis ( oral

vaccine), Measles, Mumps, vaccine), Measles, Mumps, Rubella, Plague, Tularemia, etc.Rubella, Plague, Tularemia, etc.

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

Inactivated vaccinesInactivated vaccines

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

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

Cholera, Polyomielitis, as their Cholera, Polyomielitis, as their immunogenic properties are immunogenic properties are

preserved.preserved.

Recombinant vaccinesRecombinant vaccines

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

ToxoidesToxoides

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

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

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

Protective antigensProtective antigens

Immunizations ubstances Immunizations ubstances related to the pathogenic related to the pathogenic

factors of bacterial and virus factors of bacterial and virus cells. Such antigens are cells. Such antigens are

discovered lately in Plague discovered lately in Plague and Whooping- cough and Whooping- cough

bacteria, Anthrax bacilli, bacteria, Anthrax bacilli, Rickettsias, etc.Rickettsias, etc.

SerumsSerums

Immune preparations proving Immune preparations proving passive immunologic passive immunologic

prevention for as short time ( prevention for as short time ( 2-4 weeks). They are ready- 2-4 weeks). They are ready- made antibodies ( Anthrax, made antibodies ( Anthrax,

Tetanus, Botulism, Tetanus, Botulism, Diphtheria).Diphtheria).

Application of vaccines, serums Application of vaccines, serums and immunoglobulinsand immunoglobulins

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

method.method.

Post immunization reactions of Post immunization reactions of the organismthe organism

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

Local- hyperemia and edemaLocal- hyperemia and edema

Post immunization Post immunization complicationscomplications

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

encephalitisencephalitis

ContraindicationsContraindications

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

Specific for the diseaseSpecific for the disease

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

Compatibility of the Compatibility of the immunizationimmunization

The scheme and doses of the The scheme and doses of the vaccinesvaccines

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

Disinfection of the centre of Disinfection of the centre of infectioninfection

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

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

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

and contaminating the and contaminating the environment.environment.

Disinfection performed during Disinfection performed during the course of the disease is the course of the disease is called called current disinfection. current disinfection.

After recovery of the patient, After recovery of the patient, its hospitalization or after a its hospitalization or after a

lethal outcome- the lethal outcome- the final final (ending)(ending) disinfectiondisinfection is is

performed.performed.

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

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

disinfection.disinfection.

SterilizationSterilization

A method for elimination of all A method for elimination of all microorganisms microorganisms

( pathogenic, saprophyte, ( pathogenic, saprophyte, viruses, bacteria) in their viruses, bacteria) in their

different forms- vegetative different forms- vegetative and spores.and spores.

SanitationSanitation

A method for the rapid A method for the rapid reduction of the microbial reduction of the microbial

flora in an object in the flora in an object in the environment. It is widely environment. It is widely

applied in every day life as a applied in every day life as a preventive measure.preventive measure.

Antiseptic methodAntiseptic method

A method for prevention of A method for prevention of development of development of

microorganisms of the microorganisms of the human skin and mucous.human skin and mucous.

Disinsection and derratizationDisinsection and derratization

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

Elimination of the rodents, Elimination of the rodents, natural reservoirs of natural reservoirs of

infections.infections.

Methods of disinfectionMethods of disinfection

Biological method- biological Biological method- biological filters for decontamination of the filters for decontamination of the water ( on the base of the water ( on the base of the microbial antagonism)microbial antagonism)

Physical method- sun shining, Physical method- sun shining, ultraviolet rays, ionizing ultraviolet rays, ionizing radiation, ultrasound, dry heat radiation, ultrasound, dry heat for sterilization by dry air, wet for sterilization by dry air, wet heat- sterilization and vepour heat- sterilization and vepour under pressureunder pressure

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

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

Methods of disinsectionMethods of disinsection

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

arthropods- predatory animals arthropods- predatory animals ( the fish Gambusia), parasites, ( the fish Gambusia), parasites,

pathogenic microorganisms pathogenic microorganisms ( Bacillus thuringiensis), ( Bacillus thuringiensis),

genetical hanged, sexually genetical hanged, sexually steril populationsteril population

Mechanical method- Mechanical method- cleaning, washcleaning, wash

Physical method- high Physical method- high temperature- hot dry and wet temperature- hot dry and wet air for vapouring, air for vapouring, sterilization, burning outsterilization, burning out

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

larvaelarvae- Acaricides- for elimination of Acaricides- for elimination of

acarsacars- Ovocides- for elimination of Ovocides- for elimination of

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

weedsweeds

Attractants- attracting insectsAttractants- attracting insects

Repellents- repelling insectsRepellents- repelling insects

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

- Fumigants- gas insecticides- Fumigants- gas insecticides- they act trough the they act trough the respiratory systemrespiratory system

- Intenstinal insecticides- Intenstinal insecticides- trough the digestive tracttrough the digestive tract

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

Methods of derratizationMethods of derratization

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

lack of access of the rodents lack of access of the rodents to the buildings- openings of to the buildings- openings of drainage, door stillsdrainage, door stills

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

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

killers of the rodentskillers of the rodents- Mechanical method- use of Mechanical method- use of

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

chemical compounds- chemical compounds- rodenticidesrodenticides