QUESTIONARY
IN THE COMPULSORY DISCIPLINE
“EPIDEMIOLOGY, INFECTIOUS DISEASES, MEDICAL PARASITOLOGY AND TROPICAL
MEDICINE”, included in the curriculum for specialty of “Medicine’’, for students in
5th year
***varicella, pertussis, cholera, scarlett fever
1. Epidemiology - definition, goals, tasks and methods, relation to other
disciplines, modern development.
2. Parasitism and infectious process - the biological basis of the epidemic
process. Characteristics
3. Epidemic process - definition, elements, epidemic focus, forms
4. Source of infection: human - animal, sick - forms, contagious period,
epidemiological significance. Carrier of infection - types, durability,
significance
5. Mechanisms of transmission of the infection - biological relation, types,
phases, transmission factors. The roads of infection spreading.
Classification of communicable diseases
6. Factors of infection transmission: water, food products, environmental
objects, soil, air, live vectors.
7. Population susceptibility - non-specific and specific factors,
immunological structure of the population.
8. Immunoprophylaxis. Types of vaccines. Application method. Side
reactions after vaccination. Medical contraindications for the application
of vaccines. Organization of immunizations in the Republic of Bulgaria -
levels of immunization coverage.
9. Social Factor - Impact on the epidemic process.
10.Natural factor - impact on the epidemic process. Natural - focal
infections.
11.Forms of epidemic process - sporadic, epidemics (types), pandemics,
epidemic outbreak.
12.12. Epidemiological study - purpose, stages, mode of conduct,
epidemiological analysis.
13.General preventative and basic control measures in the epidemic focus -
to the patient, the contact persons and the environment.
14.Epidemiological control and surveillance of infectious diseases.
15.Health-care associated infections (HCAI). Organizing and conducting of
epidemiological surveillance and control in the Republic of Bulgaria.
16.Problems of the liquidation of the infectious diseases
17.Disinfection and sterilization.
18.Disinsection - definition, methods, tools. Epidemiological significance.
, 19.Deratisation - definition, methods, tools. Epidemiological significance.
20.Bioterrorism. Diseases subject to international health regulation.
21.Emerging and re-emerging diseases - definitions, classification,
epidemiological features and control.
22.Infection, infectious process, infectious disease.
Infection occurs when infectious agent enters the body, may or may not lead to disease
Not synonymous with infectious disease
Infectious process – interaction between pathogenic microorganism and host, circular chain with
6 links:
Entry of pathogen into body
Local multiplication and spread
Systemic spread and multiplication
Exit
Infectious disease: nosological isolated infectious process expressing 6 characteristics of
infectious disease:
Infectious diseases are caused by specific agents
The agents enter via specific route
Characterized by periodicity and cyclic recurrence
Usually contagious diseases (communicable) spread from person to person
Lead to specific immunity after recovery
Phases: incubation, prodromal, clinical, decline, recovery.
Types of infection: manifested, subclinical, persistent, exogenous, acute, mixed, endogenous,
coinfection, secondary, superinfection, reinfection, relapse
Routes of transmission: skin-skin (herpes 1), mucus-mucus (STI), across placenta (toxoplasma)
through breast milk (HIV) sneeze-cough (influenza)
23.Diagnostic approach to infectious diseases, general syndromes, clinical
epidemiological, microbiological, virological investigations.
, 24.Symptomatic therapy, diet and regime of the infectious patient
Anti-infectious therapy should be started as soon as possible
Functional tests should be done to find most likely diagnosis before starting treatment
Treatment should be complex – bed rest, diet, etiologic, pathologic and symptomatic
Should be consistent with age, sex, epidemio
Consistent with the clinical form of the disease and present complications
Bed rest – for sepsis, chickenpox, mumps, hemorrhagic fevers – reduced energy and preserves
strength to aid recovery
Diet should be healthy and balanced, consistent with current disease and complications, different
foods required for different types of infections.
25.Pathogenic treatment in infectious diseases
26.Etiological treatment in infectious diseases
Aims to target the offending etiological agent – bacteria, virus, parasite, fungi
Principles:
Start as soon as possible
Chosen drug should be consistent with diagnosis
Form of ab should be appropriate for disease and clinical form
Duration depends on disease and severity + patient condition
No indications for antibiotics in viral infections
Monitoring of adverse reactions
27.Typhoid fever and paratyphoid fever A and B
Typhoid fever – cyclic systemic infectious disease due to salmonella enterica serovar typhi
Called enteric fever or typhoid fever, from enterobacteriacae family
Highest risk in india and Pakistan
Only human-human contact
Intracellular pathogen, invades gut by transcytosis, multiplies in macrophages, peyers
patches and mesenteric lymph nodes + spleen. Bacteremia occurs, infection localized to
lymphoid tissues of small intestine.
Gram neg, capsulated, rod, don’t form spores
Prodrome: malaise, headache, cough, sore throat + abdominal pain + constipation. – every
unexplained fever for more than 4 days is suspicious for typhpid fever.
After 7-10 days platau, patient very ill, splenomegaly and rose coloured spots on abdominal wall
+ typhoid tongue + abdominal tenderness and distension
First patient is constipated and then after 2 weeks severe pea soup yellow green diarrhea,
headache cough, fever and relative bradycardia.
Complications: meningitis, GI bleeding, gut perforation, peritonitis, myocarditis, kidney failure,
heart failure, thrombosis + sepsis.
Diagnosis: blood culture positive in 80% during first week, blood shows leukopenia with left shift
and toxic granules, low eosinophils (paratyphoid has leukocytosis)
Ciprofloxacin = 1st choice also ampicillin, azithromycin, chloramphenicol, 3 rd gen cephalosporins
Carriers – ciprofloxacin for 4 weeks
, 28.Food poisoning by Salmonella, conditionally pathogenic intestinal
bacteria, staphylococci and other.
Food poisoning aka gastroenteritis can be caused by a variety of organisms: salmonella,
campylobacter, shigella, salmonella, yersinia, cholera, s.aureas, e.coli, c.dif, c.perfringens.
Diarrhea can be inflammatory – colonic involvement by invasive bacteria frequent bloody
small volume stools + fever, cramps and urgency.
Non-inflammatory – milder, caused by viruses or toxins osmotic diarrhea, rotavirus, norovirus,
cholera, e.coli, lamblia/
Food poisoning is caused by toxins present in food
Fast onset – 1-6 hrs = preformed toxin
Slow onset (8-16) hours = organism present and starts to produce toxin later
Salmonella enterocolitis – due to salmonella enteretides, not killed by freezing
Infection by eating animal meat, eggs, poultry
5-72 hr incubation
Endotoxin vomiting, diarrhea, rapidly developing
Complications: exiscosis circulatory failure, sepsis
Diagnosis via cultivation of food feces or vomit
Electrolyte and water balance
Antibiotics not needed for mild disease
In severe disease ciprofloxacin , ceftriaxone
Enterotoxin forming bacteria:
E.g. c.perfringens, s.aureus, b.cereus
Off date groceries
1-16 hr incubation for s.aureus
8-16hr for cl. Perfringens or b.cereus
Nausea, vomiting, cramps, diarrhea, often no fever
Diagnosis – history an examination
Treatment – water and electrolytes
29.Botulism.
Paralytic disease due to botulinium toxin (zinc metalloproteinase) produced by clostridium
botulinum causes blocking of ACH release – neuroparalysis
Gram +, spore forming, anaerobic bacteria, cleaves snare protein
Food borne - 12-36 hr incubation, from poorly prepared canned foods, treatment is with
heptavalent botulism antitoxin
Infant botulism - days- 4 week incubation, infantile hypotonia, ptosis, floppy movements,
weakness, IV human botulism immune globulin
Wound botulism – due to spores in contaminated wounds, 10 day IP, botulinim antitoxin
from horses and surgical debridement is treatment.
Descending paralysis – flaccid paralysis descends caudally
Accommodation paralysis, mydriasis + diplopia
Dyarthria and dysphagia
Nausea, vomiting, constipation
Identify toxin in samples from serum or suspected foods
IN THE COMPULSORY DISCIPLINE
“EPIDEMIOLOGY, INFECTIOUS DISEASES, MEDICAL PARASITOLOGY AND TROPICAL
MEDICINE”, included in the curriculum for specialty of “Medicine’’, for students in
5th year
***varicella, pertussis, cholera, scarlett fever
1. Epidemiology - definition, goals, tasks and methods, relation to other
disciplines, modern development.
2. Parasitism and infectious process - the biological basis of the epidemic
process. Characteristics
3. Epidemic process - definition, elements, epidemic focus, forms
4. Source of infection: human - animal, sick - forms, contagious period,
epidemiological significance. Carrier of infection - types, durability,
significance
5. Mechanisms of transmission of the infection - biological relation, types,
phases, transmission factors. The roads of infection spreading.
Classification of communicable diseases
6. Factors of infection transmission: water, food products, environmental
objects, soil, air, live vectors.
7. Population susceptibility - non-specific and specific factors,
immunological structure of the population.
8. Immunoprophylaxis. Types of vaccines. Application method. Side
reactions after vaccination. Medical contraindications for the application
of vaccines. Organization of immunizations in the Republic of Bulgaria -
levels of immunization coverage.
9. Social Factor - Impact on the epidemic process.
10.Natural factor - impact on the epidemic process. Natural - focal
infections.
11.Forms of epidemic process - sporadic, epidemics (types), pandemics,
epidemic outbreak.
12.12. Epidemiological study - purpose, stages, mode of conduct,
epidemiological analysis.
13.General preventative and basic control measures in the epidemic focus -
to the patient, the contact persons and the environment.
14.Epidemiological control and surveillance of infectious diseases.
15.Health-care associated infections (HCAI). Organizing and conducting of
epidemiological surveillance and control in the Republic of Bulgaria.
16.Problems of the liquidation of the infectious diseases
17.Disinfection and sterilization.
18.Disinsection - definition, methods, tools. Epidemiological significance.
, 19.Deratisation - definition, methods, tools. Epidemiological significance.
20.Bioterrorism. Diseases subject to international health regulation.
21.Emerging and re-emerging diseases - definitions, classification,
epidemiological features and control.
22.Infection, infectious process, infectious disease.
Infection occurs when infectious agent enters the body, may or may not lead to disease
Not synonymous with infectious disease
Infectious process – interaction between pathogenic microorganism and host, circular chain with
6 links:
Entry of pathogen into body
Local multiplication and spread
Systemic spread and multiplication
Exit
Infectious disease: nosological isolated infectious process expressing 6 characteristics of
infectious disease:
Infectious diseases are caused by specific agents
The agents enter via specific route
Characterized by periodicity and cyclic recurrence
Usually contagious diseases (communicable) spread from person to person
Lead to specific immunity after recovery
Phases: incubation, prodromal, clinical, decline, recovery.
Types of infection: manifested, subclinical, persistent, exogenous, acute, mixed, endogenous,
coinfection, secondary, superinfection, reinfection, relapse
Routes of transmission: skin-skin (herpes 1), mucus-mucus (STI), across placenta (toxoplasma)
through breast milk (HIV) sneeze-cough (influenza)
23.Diagnostic approach to infectious diseases, general syndromes, clinical
epidemiological, microbiological, virological investigations.
, 24.Symptomatic therapy, diet and regime of the infectious patient
Anti-infectious therapy should be started as soon as possible
Functional tests should be done to find most likely diagnosis before starting treatment
Treatment should be complex – bed rest, diet, etiologic, pathologic and symptomatic
Should be consistent with age, sex, epidemio
Consistent with the clinical form of the disease and present complications
Bed rest – for sepsis, chickenpox, mumps, hemorrhagic fevers – reduced energy and preserves
strength to aid recovery
Diet should be healthy and balanced, consistent with current disease and complications, different
foods required for different types of infections.
25.Pathogenic treatment in infectious diseases
26.Etiological treatment in infectious diseases
Aims to target the offending etiological agent – bacteria, virus, parasite, fungi
Principles:
Start as soon as possible
Chosen drug should be consistent with diagnosis
Form of ab should be appropriate for disease and clinical form
Duration depends on disease and severity + patient condition
No indications for antibiotics in viral infections
Monitoring of adverse reactions
27.Typhoid fever and paratyphoid fever A and B
Typhoid fever – cyclic systemic infectious disease due to salmonella enterica serovar typhi
Called enteric fever or typhoid fever, from enterobacteriacae family
Highest risk in india and Pakistan
Only human-human contact
Intracellular pathogen, invades gut by transcytosis, multiplies in macrophages, peyers
patches and mesenteric lymph nodes + spleen. Bacteremia occurs, infection localized to
lymphoid tissues of small intestine.
Gram neg, capsulated, rod, don’t form spores
Prodrome: malaise, headache, cough, sore throat + abdominal pain + constipation. – every
unexplained fever for more than 4 days is suspicious for typhpid fever.
After 7-10 days platau, patient very ill, splenomegaly and rose coloured spots on abdominal wall
+ typhoid tongue + abdominal tenderness and distension
First patient is constipated and then after 2 weeks severe pea soup yellow green diarrhea,
headache cough, fever and relative bradycardia.
Complications: meningitis, GI bleeding, gut perforation, peritonitis, myocarditis, kidney failure,
heart failure, thrombosis + sepsis.
Diagnosis: blood culture positive in 80% during first week, blood shows leukopenia with left shift
and toxic granules, low eosinophils (paratyphoid has leukocytosis)
Ciprofloxacin = 1st choice also ampicillin, azithromycin, chloramphenicol, 3 rd gen cephalosporins
Carriers – ciprofloxacin for 4 weeks
, 28.Food poisoning by Salmonella, conditionally pathogenic intestinal
bacteria, staphylococci and other.
Food poisoning aka gastroenteritis can be caused by a variety of organisms: salmonella,
campylobacter, shigella, salmonella, yersinia, cholera, s.aureas, e.coli, c.dif, c.perfringens.
Diarrhea can be inflammatory – colonic involvement by invasive bacteria frequent bloody
small volume stools + fever, cramps and urgency.
Non-inflammatory – milder, caused by viruses or toxins osmotic diarrhea, rotavirus, norovirus,
cholera, e.coli, lamblia/
Food poisoning is caused by toxins present in food
Fast onset – 1-6 hrs = preformed toxin
Slow onset (8-16) hours = organism present and starts to produce toxin later
Salmonella enterocolitis – due to salmonella enteretides, not killed by freezing
Infection by eating animal meat, eggs, poultry
5-72 hr incubation
Endotoxin vomiting, diarrhea, rapidly developing
Complications: exiscosis circulatory failure, sepsis
Diagnosis via cultivation of food feces or vomit
Electrolyte and water balance
Antibiotics not needed for mild disease
In severe disease ciprofloxacin , ceftriaxone
Enterotoxin forming bacteria:
E.g. c.perfringens, s.aureus, b.cereus
Off date groceries
1-16 hr incubation for s.aureus
8-16hr for cl. Perfringens or b.cereus
Nausea, vomiting, cramps, diarrhea, often no fever
Diagnosis – history an examination
Treatment – water and electrolytes
29.Botulism.
Paralytic disease due to botulinium toxin (zinc metalloproteinase) produced by clostridium
botulinum causes blocking of ACH release – neuroparalysis
Gram +, spore forming, anaerobic bacteria, cleaves snare protein
Food borne - 12-36 hr incubation, from poorly prepared canned foods, treatment is with
heptavalent botulism antitoxin
Infant botulism - days- 4 week incubation, infantile hypotonia, ptosis, floppy movements,
weakness, IV human botulism immune globulin
Wound botulism – due to spores in contaminated wounds, 10 day IP, botulinim antitoxin
from horses and surgical debridement is treatment.
Descending paralysis – flaccid paralysis descends caudally
Accommodation paralysis, mydriasis + diplopia
Dyarthria and dysphagia
Nausea, vomiting, constipation
Identify toxin in samples from serum or suspected foods
