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Posted on May 19th, 2012, by

National guidelines are series of practical guideline on basic medical specialties, including all basic information, necessary to a doctor for continuous education. Unlike other most guideline, in national guideline equal attention is spared to a prophylaxis, diagnostics, pharmacotherapy and unmedical methods of treatment.  National guideline contains the “Infectious diseases” modern information about organization of service of infectious help, about the methods of diagnostics and treatment of infectious diseases. In edition recommendations are first resulted on basic clinical syndromes, the most meaningful diseases are lighted up in detail. An appendix to guideline on a compact disk includes additional illustrations and pictures, pharmacological reference book, normatively-legal documents, standards of conduct of patients, medical calculators. In preparation of the real edition leading specialists took part as authors-compilers and reviewers. All recommendations revved the stage of the independent criticizing. It is intended for infectious diseases specialists, home doctors, general practitioners, students of senior courses of medical institutes of higher, house physicians, interns, and graduate students.

In the second edition of reference guide in detail basic information is presented about etiology, epidemiology, clinic of infections, having epidemic character of distribution, heavy complicated flow (HIV-infection, flu, diphtheria, viral hepatitis and other), and also about diseases which not enough know the wide circle of doctors (haemorrhagic fevers, illness of Lime, campilobacteriosis and other infections). The special attention is spared to early diagnostics, providing of the first medical aid, treatment in ambulatory terms, health centre system. For preparation of guideline authors used long-term experience of clinical and pedagogical practice, and also results of scientific researches.

Guideline is intended for general medical workers, infectious diseases specialists, epidemiologists, and also practicing doctors of many other specialties.

Hardy (1993) stated that reform of the system of domestic health protection supposes to approach to the patient medical aid on the prehospital stage. Enormous amount of policlinics, built in days gone by, thousands of geared-up doctors and medical sisters did not promote quality of diagnostics and treatment substantially. A district internist, having the large loading and not prepossessing a modern material and technical base, grew into a controller, sending a patient or to the «narrow» specialists, or on hospitalization. A doctor divided responsibility for a patient with many specialists, qualification went down as a result, professional interest and prestige fallen down. The developed program of re-erecting of health protection takes into account all complex of terms of existence of man, family, collective, and society. It engulfs all factors, influencing on a health population: deposit of health protection and medicine (8,5-10%), way of life (50%), heredity (20%), state of environment (20%). In this connection the necessity of change the role of district internist came to a head for the system of health protection.

Really doctors and medical sisters of general practice will appear on the workplaces over the years, as their serious preparation is required. But already teaching of medical workers is now begun on the specially developed programs.

In these programs the special attention is spared not only to pathology but also to prophylaxis.

Infectious diseases, as well as in former years, continue to occupy one of leading places among the diseases of man.

Problems of viral hepatitis are actual, sharp intestinal infections. Rushing (1995) demonstrated that the diphtheria, forgotten a long years ago, returned from past years, new infections got wide distribution, caused by different viruses and a threat for humanity is presented by AIDS. In the conditions of socio-economic changes, resulting in stratification of society, to appearance of large number socially unscreened people, many infectious diseases purchased a heavy flow, quite often with a mortal end. Modern achievements of virology, to immunology, it was allowed the applied pharmacology to revise looks infectious diseases specialists to etiology, pathogeny of many illnesses and to attain certain successes in treatment. However, picture that infectious diseases must know mainly infectious diseases specialists, is wrong in its root. General practitioners meet the first with infectious patients. Early recognition of infection, determination of correct therapeutic tactic, organization of disease measures, depend exactly on their qualification, and in the end is a fate of patient and prosperity of circumferential to him people. It is confirmed high daily lethality in infectious permanent establishment, arriving at 30% from all dying patients.

I think that it is good position that authors considered necessary the syndromic going near illnesses to fasten by the detailed description of nosology forms, especially those, which purchased an epidemiology value presently, got new interpretation or are little known the wide circle of clinicians.

Modern information about the structure of viral hepatitis, illness of Lime, diphtheria, the dysenteries will help general practitioners to decide concrete clinical tasks. To the authors, leaders of infectious service, the queries of practical health protection are well known; they have a rich experience on optimization and perfection of measures on a fight against infections that found a reflection in guideline. Methodical recommendations on sharp intestinal infections, viral hepatitis, illness of Lime, diphtherias et al, developed leading specialists and ratified by a committee on a health protection, organically entered in the structure of guideline and are the unique feature of this edition.

Guideline is intended for general specialists, pediatricians, internists’ practitioners. It can be used by infectiologists, gastroenterologists, dermatologists, neurologists, rheumatologists and other specialists.

One famous scientist marked: «To the group infectious it is possible to take 98% all diseases. If to think a little about this percent –  99,8%. And if to think more – all 100%». Indisputably, it is an overstatement, but a part of stake truth is in the words of scientist.

Let’s discuss according to chosen guideline Infectious deseases: What does it consist of? Any disease is a sign of weakening of organism of man. On a background hyposthenic immunity, infecting takes place especially easily, what organ or system will appear affected – determined the set of etiologic factors. At the same time enough hardness infections to develop in a healthy organism. A healthy organism it is, foremost, the healthy immune system.

Immunity is supported by the healthy way of life. The World health Organization has defined health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

These guideline maxims have to be reminded a future general practitioner on that reason, that modern medicine has a heel in valeology, i.e. in conception of fight of organism with illness, in harm to that direction, which forming, strengthening and maintenance of health is underlaid. However, uniquely fruitful approach consists of combination of sanology with valeology. Ancient Greeks it fine understood, and not for nothing the goddess of health carried the name of Gigeya for them. It is possible to remember more early times – about 2000 years B.C. Already in this period laws, directed on a health care, were formulated in Mesopotamia, i.e. laws, regulating hygienically bases of making healthy of population. In course of time Gigeya as character of medicine appeared practically forced out the second daughter of Asklepiya by Panacea, and the role of hygiene was taken only to protecting of organism from the unfavorable for a health factors of external environment.

Today world medical science far stepped back from primitive interpretation of health as absence of illnesses. It is said in the preamble of regulation of worldwide organization of health protection: «A health is the state of complete physical, spiritual and social prosperity, rather than just absence of illnesses or physical defects».

Last years WHO sufficiently successful propagandizes a simple formula: «more healthy choice is more easy choice».

The European bureau developed by WHO and in a great deal realized the program «The Healthy lifestyle». Idea of way of life as a factor, determining a health, at the beginning of 80th designed as conception, in the basis leaning both against the results of epidemiology researches and on achievements in area of social sciences. Conception of «way of life as a factor, determining a health» was accepted as one of head stone of the program of the European bureau of WHO.

This philosophy of health must become basic and for a future general practitioners. Time of doctors in a clean kind goes away to the past. Time of rehabilitation of Gigeya comes, i.e. high-quality other going near a health of people care and to the idea of prophylaxis. Exactly a general practitioner becomes a key figure here. On expression of academician Amosov to «be healthy, own efforts, permanent and considerable, are needed. Replacing them is impossible nothing». To initiate these efforts and give them necessary direction can and a general practitioner must.

Looking after not only adults but also children, he gets unique possibility to mortgage in consciousness of people a requirement in a healthy lifestyle in the earliest age. Designating this important aspect, we pass to the practical prophylaxis of infectious diseases taking into account those important changes which bring in socio-economic realities of present time in it.

Guideline includes not only description, methods of treatment of different infectious diseases but also social roots of their appearance. It is generally known, that social shocks, especially wars, always entailing economic problems, result in wide distribution of epidemic diseases. History knows that mass of examples. We will remember even the period of Great strife, catastrophic drought at the end of XIX century and accompanying by it cholera or «typhus» times of Civil war. Similar, though not so catastrophic situation, is observed and in modern country. Such illnesses, as HIV-infection, viral hepatitis, tuberculosis, gonorrhea, collect dangerous growth. Naturally, that growth of specific gravity of infectious diseases requires the improvement of preparation of specialists, answering the requirements of today’s reality. Preparation of infectiologists must have a greater volume and substantially other orientation incomparably, what, for example, in such socially and, consequently, epidemiology to the happy country, as Sweden. Undoubtedly, what in preparation of general of infection practitioners must occupy proper a situation place?

The picture of infectious morbidity changed not only in number but also high-quality. A situation is an especially model with such illness, as diphtheria. If in 50th of XX century the students-physicians were in an only theoretical position of acquaintance with, in 90th index of morbidity made much more. Vaccination is important method of struggle with infectious diseases. Vaccination as one of the effective ways of treating the diseases mentioned above.

Vaccination is the giving of antigens from a disease-causing organism, either by injection or orally, with the aim of causing the body’s immune system to learn to make antibodies against the disease. The body should be able to respond fast enough to infection by that disease to eliminate it before symptoms develop. Another factor which must be taken into account is that diseases can spread across international boundaries, so one the role of World Health Organization is to have in addition to national policies, a worldwide coordinated approach. The conducted sociological questioning rotined that population:

а) does not know about the epidemic of diphtheria;

b) is afraid to be infected AIDS during a vaccination;

c) does not find time to vaccinate;

d) is afraid of complications.

In the last a serious negative role was played by the press in which information appeared that vaccination it is better not to do from diphtheria, as a domestic vaccine is off-grade, has too much contra-indications, weakens immunity and so on, it added that the forced vaccination violates human rights. But providing sanitary-epidemiology prosperity in a country just and directionally on the observance of human rights! Research of social status diseased diphtheria allowed selecting among them three basic categories – children of preschool age, schoolboys and unworking pensionaries. Children appeared uninstiled from pure resistance of parents, and unworkings pensionaries, unlike a working population, fallen out of sphere of attention of infectiologists. Unfortunately, infectiologists can not reach to every family, and all hope -is on general practitioners. To disperse afore-mentioned errors, similarly as well as to watch after a scope the inoculations of all patients is his duty.

Other side of problem, having the expressed social roots, is the sharply growing alcoholizing of population. Among dying from diphtheria in 1993 in the country 80% made persons, sufferings alcoholism, which not only the general hyposthenicness of organism is characteristic for but also, by virtue of frivolous attitude toward the health, late turned to the doctor. Statistics also show that about 80% make alcoholics and among the habitants of country, dying from a dysentery and viral hepatitis. They, by reason of the illegibility in intimate connections, most subject to the risk of diseases, transmissible sexual a way, such as a gonorrhoea and syphilis, opening the gate of HIV-infection in same queue.

Non-drinking propaganda is business difficult and more frequent than all ungrateful because it is depersonalized.

But it can purchase other emotional coloring high-quality, if a general practitioner is in an usual for a patient home situation, in confiding conversation, on the concrete (and that is why more easy to understand) examples of death of patients by alcoholism from diphtheria, dysentery or viral hepatitis will carry to the concrete, separately taken man, to what can bring his pernicious predilection over.

Another extrahazardous social source of infectious diseases is the so-called sexual revolution (or, on determination of some researches sexual rebelling) which is experienced by our country. A population stands on the threshold of epidemic of HIV-infection and AID, and a domestic doctor must become a key figure in the prophylaxis of this disease. The atmosphere of socializing with people in an informal home situation disposes to the confiding human contacts, to facilitating the discussion of such delicate problems, as a sexual culture, safe sex and rules of life in the era of AIDs.

Nowadays according to all guidelines general practitioner is important as guarantor of early diagnostics. Our guideline answered on the question: Is the place of infections which in-process doctor? Pediatricians and internists will answer this question variously. In practice of first communicable diseases have greater specific gravity, because, at first, child’s organism possesses less resistive capacity to the infections, and secondly, parents usually speak to the doctor at the first anxious signs. Adults rarer speak to the doctor, and physicians quite often are inclined not to register infectious diseases, especially sharp intestinal, to avoid tiresome formalities. It finds the reflection in the incidents of statistics. As it is generally known, the most widespread infectious diseases are a flu, viral hepatitis and sharp intestinal infections. However besides that, for example, viral hepatitis, find out an obvious tendency to growth, increases of amount of sharp intestinal infections – at those socio-economic factors – not marked. In the same time there is information about growth of lethality from these infections. What does it mean? Only one – sharp intestinal diseases register far not always.

From here enormous daily lethality among hospitalized appeared (at 20% from dying death came in the first days of their stay in a hospital). Almost the half of fatal outcomes from sharp intestinal infections is registered in the first three days after hospitalization of patients. It is the same possible to say and about diphtheria. Hospitalization of patients with this infection quite often takes place extraordinarily lately – on the 7-10th day of disease. The postponement of beginning of treatment leads if not always to death, almost always to complications of cardiologic or neurological plan. Frankly speaking, a general practitioner is irreplaceable here. Foremost, he has a right to hospitalize a patient with any suspicious quinsy. Further, he is under an obligation to conduct prophylactic work in a family, as domestic hearths of diphtheria are most numerous. Ryan and Ray (2004) were sure that exactly a general practitioner is under an obligation to provide epidemiology regime. And, finally, taking into account marked before, – to point all family members at an inoculation, regardless of age. These information sufficiently eloquent it is talked about the necessity of increase of specific gravity of teaching of infectious diseases for preparation of general practitioners and reorientation of it on a prophylaxis, and early diagnostics.

Today’s realities require the revision of attitude toward chronic hepatitis. Existed and opinion exists yet, that this illness does not behave to infectious. Meantime, it was formulated conception about 5 nosology forms of viral hepatitis, where included chronic hepatitis and hepatocirrhosis, considering it a viral disease. «Australian» antigen then yet was just opened, and this conception in the scientific world was perceived negatively, but time confirmed the rightness of scientist: today test-systems is already developed for confirmation of viral etiology of a number of sharp and chronic diseases of liver.

Therefore, a general practitioner always must remember that to any patient it is needed to befit chronic hepatitis as to the infectious patient. There can not be chronic hepatitis without an exciter, except for 5-7% cases, being on the stake of the inherited pathology or unfavorable factors of external environment. Chronic hepatitis can not be the end of sharp infectious process is the form of flow of infectious process. Therefore and around patient with chronic hepatitis domestic epidemiology spots is formed, that does providing in these hearths of epidemiology regime on principle important. Implementation of this function also lies on a general practitioner, thus this mode not temporal, but permanent – chronic hepatitis requires the lifelong health centre system, and that is why the family of such patient must remain in the field of intent attention of general practitioner actually forever.

In the last few years, as we talked already, morbidity by viral hepatitis In and With grew sharply. And they – along with syphilis and gonorrhea – passed (including) sexual a way, i.e. the same as and exciter of AIDs. Therefore for a general practitioner universal watchfulness must be formed. Most essential, determining a flow and end of disease, there is the first link – general practitioner. Ryan (2002) said that the value of high-quality preparation of general practitioners on infectiology becomes obvious during the flashes of infectious diseases, in periods of socio-economic problems. A general practitioner, meeting the first with a patient, is under an obligation to be able to collect clear anamnestic information, not forgetting about epidemiology anamnesis, to conduct valuable examination of patient.

The complex of these information determines early diagnostics and, if necessary, urgent therapy on the primary stage. The leadthrough of necessary disease measures is provided by safety of circumferential the patient of people or, opposite, allows exposing the source of infection – transmitter or patient with a low-intensity or chronic disease.

In difficult diagnostic cases it is necessary to draw on laboratory researches. According to Watts (2003) we see that informing are methods express diagnosticians, cooperant early diagnostics and decision of questions of epidemiology inspection. The row of patients with the easy flow of disease, after registration, can treat oneself ambulatory without bringing in of infectiologist. For example, flu,  sharp intestinal infection in default of epidemiology recommendations to hospitalization. In diagnostically difficult cases a general practitioner attracts special doctor and decides jointly with him question of treatment on a house at. If necessary hospitalized sick in infectious permanent establishment with nosology or by a syndromic diagnosis. In every situation, jointly with doctor or without him, it is necessary to decide a question – to hospitalize a patient or treat without hospitalization at home.

It is necessary to be stopped for the basic functions of special doctor. Doctor of separation (cabinet) infectiously-parasitogenic diseases and immunoprophylaxis of policlinics conducts and provides:

– consultative help to a patient in a policlinic and on to the house with the purpose of clarification of diagnosis, settings medical, diagnostic and prophylactic measures, and in the case of necessity make decisions of question about hospitalization;

– consultative help to the doctors of policlinic on treatment of infectious patients in ambulatory terms and on to the house, to completing finish the cure after an extract from permanent establishment besides patients, carrying a cholera, typhoid, paratyphoid, dysentery, salmonellosis, viral hepatitis, brucellosis, malaria, hemorrhagic fever, which are subject a clinical supervision, and also bacillicarriers of typhoid, paratyphoid sticks;

– consultation of general practitioners on questions of inspection of patients, suspected on an infectious disease and about the order of their sending to hospitalization;

– systematic work on the increase of knowledge of doctors, making ambulatory reception, on questions of early diagnostics and providing of skilled help an infectious patient;

–  a clinical inspection and treatment of ill people and bacillicarriers on the set list, subject a dynamic supervision in the infectious rooms of diseases, except for patients with the irreversible consequences of the carried infectious diseases;

–  an account of patients by infectious diseases, bacillicarriers and parasitizes, analysis of dynamics of infectious morbidity and death rate, to efficiency of diagnostic and medical measures, control after implementation of plan of leadthrough of prophylactic inoculations both on the whole on a policlinic and on separate medical areas;

– propaganda of medical knowledge on a prophylaxis and providing of primary medicare at infectious diseases.

Doctor is under an obligation:

– to examine temporal disability in accordance with position about examination;

– high-quality and in good time to conduct a medical document, ratified registration-current forms and to make a report on the activity.

In infectious permanent establishment treatment of patient is foreseen in a sharp period of infection, whereupon he again goes back into a policlinic.

The existing presently structure of the specialized infectious service, interactive with epidemiology, needs perfection.

In the present shows new problems, conditioned by the change of specific gravity of different infections in pathology of man, appeared, factors of epidemic process, pathogeny and clinical flow of many forms and, consequently, by growth of difficulties of diagnostics and treatment. All of it grounds on the necessity of development of new organizational forms, certainly, on the basis of already present and answering the modern stage of infectiology in the new terms of economic development.

I strongly believe that further perfection of infectious service is implied by strengthening of the specialized help on the ambulatory stage, development and deepening of bilateral connections, succession between infectious permanent establishments and by an ambulatory-policlinic by a link, and also approaching of highly skilled and specialized help to the population. For this purpose above all things it is necessary to equip all separations (cabinets) infectiously-parasitogenic diseases and immunoprophylaxis of policlinics to the computers and with modem connection with the specialized permanent establishments. All infectious permanent establishments must have the specialized transport, equipped with modern medical equipment, ready for departure on a house to the patient, for consultation or providing of the first specialized aid, settings of therapy and if necessary are hospitalizations.

Experience in modern terms rotined expedience along with permanent establishment, executing the functions of territorial center of infectious service, to have the specialized clinics at research institutes, and also infectious separations in multisectoral permanent establishments; last at an unfavorable epidemiology situation can be fully change the specialty on the reception of infectious patients and vice versa.

It is also expedient to have a complex of requiring payment services for patients which want them to get. These facilities, additionally to get from a budget, can be instrumental in development of infectious service. Taking into account that in the fund of obligatory insurance facilities are stopped up on prophylactic activity, it is necessary also to use them for epidemic situations. It is necessary to spare large attention the specialized clinics, because they decide the complex of scientific and practice tasks, using potential of the laboratories. Specialized clinics on scientific basis, taking into account world experience must in full provide a complex of treatmental, diagnostic and rehabilitation measures at the proper nosology forms. Such approach within the framework of this guideline implementation will allow rationally expending facilities on treatment of infectious patients with upgrading medicare.

Thus, taking into account all above stated information taken from chosen guideline and analyzing many information sources in relate to the topic of our research I can make a conclusion that it is well-organized guideline that allow doctors to find many answers on their question about infectious diseases. For the conclusion I want to say that this guideline needs no changes, because it was written by good specialists and it has new and appropriate information about infectious diseases for today. Evaluating this guideline I found new interesting information and I also think that such research work will help me in future to be more qualified in questions connected with infectious diseases.

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