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Various Infectious Diseases (Epidemic parotitis  (mumps) (clinical course…

- - - - Frequent in the moderate climate, especially in winter
        caused by group A streptococcus
        The infection most often affects children 5-15 years
        Asymptomatic carriers among children - 5-20%
        More frequently among people in large groups,
    - - Direct contact with secretion from respiratory tract,
        Less frequently by means of droplet infection or indirect contact of hands
        Cases of infection of food and milk were reported
    - - Incubation period – 2-5 days
        Sudden onset of the disease,
        Sore throat, fever, malaise, abdominal paine, vomiting
        Changes on the tonsils and palate arches (reddening, purulent plugs) – if extensive changes - problems with swallowing, fuzzy speech
        White coating on the tongue
        Enlargement of the nearest lymph nodes (neck, submandibular)
    - - Clinical picture
        Leucocytosis shifted to the left
        Higher values of C-reactive protein
        Pharyngeal swab (fast finding of the antigen – sensivity of the test 50-90%, specificity >95%; culture),
        Finding the antibodies against streptolysin (ASO) (limited utility, production of antibodies may be delayed even up to 4 weeks), importance in diagnostics of complications (rheumatic fever, glomerulonephritis)
    - - Early
        
        Peritonsillar abscess (quinsy),
        
        Otitis media
        
        Sinusitis
        
        Endocarditis
        
        Sepsis
      - Late
        
        Rheumatic fever
        Glomerulonephritis
        Erythema nodosum (nodal fever)
    - - Infectious mononucleosis
        Different bacterial etiology - M.pneumoniae, infection with Coxsackie viruses, adenoviruses; fungal etiology
        Plaut-Vincent angina, Ludvig’s angina
        Changes in the throat in the course of non-infectious diseases:
        agranulocytosis, leukaemia, neoplastic changes, peritonsillar abscess
    - - Antibiotitherapy - penicillin, semisynthetic penicyllin, cephalosporin, macrolide
        
        Symptomatic treatment
        
        Infectivity subsides after 24 h of antibiotic therapy
        
        usually the prognosis is good
- - - - Mild forms, Rare occurrence,
        
        Diagnosis possible on the basis of the bacteriological tests,
        
        Opportunistic germs that cause pathological changes in people with immunological system defficiency
    - - The localised form – picture of catarrhal or fibrinous angina (the lightest form, occurs in adults, reddening and swelling of palatine tonsils, good general condition of the patient, usually recovery by itself)
      - Sinusal form – picture of the sinusal streptococcal angina (at the outlet of both tonsils crypts white coatings, hard coatings, after their removal the base bleeds slightly, enlargement of the nearby lymph glands – not very painful, the nauseating unpleasant smell can be felt from the mouth, temperature range up to 38 degrees, the patient is pale, feels bad (malaise), the quickened pulse disproportionate to the body temperature, uncured leads to late toxic syndromes (peripheral paralysis, cardiac action failure)
      - Progressive form (coatings spread outside tonsils, down towards the larynx, problems with swallowing, nearby lymph nodes are large and painful, fever up to 40 degrees, very fast pulse, more frequently the effect of diphtheria toxin activity: soft palate paralysis, proteinuria, cardiac insufficiency)
      - Toxic form (serious form with uncertain prognosis, dirty grey or greenish coatings, they form homogenous membranes, extending wider outside the limits of the tonsil, they reach deeper into the mucosa, not so hard, rotting smell from the mouth, serious condition of the patient, pale, dark rings around eyes, fast, meagre filled pulse, damp skin, temperature 38-40 degrees, large submandibular and neck lymph glands – levelling of the neck profile – proconsul Neron’s neck, toxic symptoms of cardiac muscle, stimuloproductive and conductive system damage, the risk of sudden circulatory stoppage.
      - Hypertoxic form (toxic form symptoms are accompanied by haematologic disorders: granulocytopenia, agranulocytosis, symptoms of general haemorrhagic diathesis – bone marrow damage and toxic damage of the capillaries, death within 1-2 days, more frequently on 7-10th day of the disease.
    - - Presently very rare, particularly dangerous form for children,
        
        There are formed alleged membranes that cover the internal surfaces of the larynx,
        
        Barking cough, hoarseness, voicelessness,
        
        Respiratory difficulties (narrowing of the larynx due to growing membranes),
        
        Risk of suffocation,
- - - - Normally the swelling of one parotid gland, after 24-48 hours the swelling of the other parotid gland, sometimes simultaneous swelling on both sides,
        
        Oedema gradually spreads (occasionally simultaneously affecting both submandibular salivary glands),
        
        The face begins to look like a pear,
        
        The skin is tense, warm, is not red, pain at pressure,
    - - Reddening, oedema of the salivary gland duct outlet (Stensen’s duct),
        
        Reddening, softening (malacia) of the throat mucosa and the internal side of the cheeks on the molar teeth level,
        
        Most frequently decreased saliva secretion, sensitivity to the sour flavour
    - - Increases even up to 41 degrees alongside the occurrence of the oedema,
        
        Small children may have the feverless course of the disease,
        
        Lityc fall within 3-4 days,
        
        Occurs again after affecting the other salivary gland (does not reach the primary value),
        
        The further course feverless,
        
        In the incidence of complications the next surge of fever,
  - - - It precedes the swelling of salivary glands for 4-7 days,
        
        May be an isolated incidence,
        
        Short course - 2-3 days,
        
        Sudden strong pain in the left epigastrium (upper part of abdomen) (painfulness at pressure in the left upper quadrant),
        
        Not very high fever, The patient unquiet, slow pulse
        
        Vomiting, diarrhoea, jaundice,
        
        Physical examination: muscular defence, and the skin hyperaesthesia above the navel, the abdomen below is hollowed
    - - Isolated or precedes the swelling of salivary glands,
        
        Normally at the age above 14 years – after adolescence – (the peak between 15 and 29 years of age),
        
        The onset usually towards the end of the first week of the disease,
        
        The one-sided or two-sided changes,
        
        Strong pain radiating towards the crouch and loins,
        
        Physical examination: considerable swelling and reddening of the scrotum, a testicle enlarged, sometimes pulled in epididymis
        
        Laboratory examination – leucocytosis in the blood morphology with a shift to the left,
        
        4% of the patients show spermatogenesis disability and infertility