1. MalariaPlague

2. Disease characterized by certain febrile disturbances caused by protozoa parasites class SPOROZOA family PLASMODIAE). Clinically malaria is characterized by periodic attacks of fever, associated with anemia and enlargement of liver and spleen

3. Etiology Causative agents – elementary microorganism ( 1-1,5 – 40-60 mcm ) Plasmodium vivax – 3-days malaria (P. vivax vivax - “south” stam, Plasmodium vivax – 3-days malaria (P. vivax vivax - “south” stam, P. vivax hibernans – “north” stam) P. malariae – 4-days P. malariae – 4-days P. ovale – oval-malaria P. ovale – oval-malaria P. falciparum – tropic P. falciparum – tropic

4. Cycles of development sexual (sporogony) – in mosquito organism sexual (sporogony) – in mosquito organism asexual (schizogony) - in human or animal spinal organisms: asexual (schizogony) - in human or animal spinal organisms: tissue (incubation period) tissue (incubation period) erythrocyte (P. malariae - 72 hours, for others – 48) erythrocyte (P. malariae - 72 hours, for others – 48)

6. Epidemiology Source – sick person, carrier Mechanism – transmissible After the bites of female mosquito Anopheles Seasonal – - summer-autumn, in tropics – whole year Susceptibility - high Immunity – non persistent, homologous

7. Pathogenesis Tissue schizogony (incubation period) Tissue schizogony (incubation period) Erythrocyte schizogony – incorrect temperature type Erythrocyte schizogony – incorrect temperature type Typical attack – massive destruction of erythrocytes, massive appearance of parasites and products of their metabolism Typical attack – massive destruction of erythrocytes, massive appearance of parasites and products of their metabolism Disturbance of thermoregulation centre, increasing of vessels penetration Disturbance of thermoregulation centre, increasing of vessels penetration Disturbance of microcirculation, water- electrolytes balance, vegetative neurotic system Disturbance of microcirculation, water- electrolytes balance, vegetative neurotic system Development of hemolytic anemia Development of hemolytic anemia Hepatosplenomegaly Hepatosplenomegaly Development of coma Development of coma

8. Malaria classification On parazite: three days (P. vivax), four days (P. malariae), malaria ovale (P. ovale), tropical (P. falciparum) On parazite: three days (P. vivax), four days (P. malariae), malaria ovale (P. ovale), tropical (P. falciparum) According to origin: hereditary, primary, inaculated (shizont), reinfection According to origin: hereditary, primary, inaculated (shizont), reinfection Stage of severity: mild, moderate, severe Stage of severity: mild, moderate, severe Duration: acute, prolonged, with early and late recidives, without recidives. Duration: acute, prolonged, with early and late recidives, without recidives. Complications: coma, hemoglobinuria fever, interruption of spleen, infectious-toxic shock, intravascular DS Complications: coma, hemoglobinuria fever, interruption of spleen, infectious-toxic shock, intravascular DS

9. Clinic symptoms of malaria Incubation period: 3-days malaria – 10-14 days (south tape) or 8-14 months. (north), Incubation period: 3-days malaria – 10-14 days (south tape) or 8-14 months. (north), 4- days– 20-25 days, tropical – 8-10 days 4- days– 20-25 days, tropical – 8-10 days Attack of fever ( chill – hot – sweat ) Attack of fever ( chill – hot – sweat ) with periods ( for P. malariae - 72 hours, for others – 48 hours) with periods ( for P. malariae - 72 hours, for others – 48 hours) Hepatosplenomegaly Hepatosplenomegaly Hemolytic anemia (icterus) Hemolytic anemia (icterus) Tachycardia, hypotonia, cyanosis, herpes, diarrhea, vomiting, pain in abdomen, back. aick

11. Diagnostic Finding of parasite in blood Finding of parasite in blood (parasitoskopy) – “fat” drop ( plasmodies in different stages of development – ring, shizont morula, gamets ), blood smear ( identification of plasmodies ) (parasitoskopy) – “fat” drop ( plasmodies in different stages of development – ring, shizont morula, gamets ), blood smear ( identification of plasmodies ) Border of identification – 5 in 1 ml, in case of coma – till 500.000 (20-25- 50 % of lesion erythrocytes) Definition of antibodies in indirect immunofluorescent reaction 1:20-1:40 ( retrospective ) Definition of antibodies in indirect immunofluorescent reaction 1:20-1:40 ( retrospective )

12. а) Pl. vivax b) Pl. malariae c) Pl. falciparum а b c

13. Differential diagnosis Influenza Influenza Epidemic typhys Epidemic typhys Typhoid fever Typhoid fever Sepsis Sepsis Viral hepatitis Viral hepatitis Pyelonephritis Pyelonephritis Leptospirosis Leptospirosis Brucellosis Brucellosis Leishmaniosis Leishmaniosis Meningococcal meningitis Meningococcal meningitis

14. Treatment Liquidation of acute attacks (hematoshizotropic agents) Warning of possible relapses (histoschizotropic) (histoschizotropic) Decontamination of sick person as source of the infection (gamontotropic)

16. Prophilaxis  Sanitarian patrolling of the state from delivery (quarantine infection contamination) Mandatory registration Mandatory registration Sterilization of toolkit Sterilization of toolkit At detection of sick or carrier – parasitoscopy examination of all family members At detection of sick or carrier – parasitoscopy examination of all family members Ant mosquito measures (melioration, usage of insecticides, repellents) Ant mosquito measures (melioration, usage of insecticides, repellents) Drug prophilaxis Drug prophilaxis

17. Drug prophylaxis One week prior to departing, all residence time in ill-behaved terrain + 6-8 weeks after homing One week prior to departing, all residence time in ill-behaved terrain + 6-8 weeks after homing After homing - preventive and ant recidive courses of Primachinum 0,027 gm/day 14 days After homing - preventive and ant recidive courses of Primachinum 0,027 gm/day 14 days

18. Plague PESTIS (A 20)

19. Plague (Pestis) – especially dangerous infectious disease, that is caused by a plague stick. Expressed by fever, severe intoxication, severe hemorrhagic inflammation of lymphatic nodes, lungs and other organs through sepsis especially dangerous infectious disease, that is caused by a plague stick. Expressed by fever, severe intoxication, severe hemorrhagic inflammation of lymphatic nodes, lungs and other organs through sepsis

20. Yersinia pestis in the blood of patient with plague

21. Possible ways of transmission: Tranmissive ; Tranmissive ; Contact; Contact; Alimentary ; Alimentary ; Droplet ; Droplet ;

22. Flea «Plague flea » Flea «Plague flea »

23. Classification: Clinical forms: skin (A 20.1), bubonic (A 20.0), skin-bubonic; primary-pulmonary (A 20.2), second- pulmonary, intestinal, primary-septic primary-pulmonary (A 20.2), second- pulmonary, intestinal, primary-septic (A 20.7), second-septic, other forms (A 20.8). (A 20.7), second-septic, other forms (A 20.8). Degree of weight: mild, moderate, severe. Complication: infectious-toxic shock, meningitis (And 20.3), adeno-phlegmone and etc

24. Example formulation of diagnosis Plague, skin-bubonic form: defect of upper third of right shoulder, inguinal bubo, severe duration. Plague, skin-bubonic form: defect of upper third of right shoulder, inguinal bubo, severe duration. Plague, second-septic form. right side inguinal bubo. infectious-toxic shock of the ІІ degree is a Disseminated intravascular coaggulopathy-syndrome. Plague, second-septic form. right side inguinal bubo. infectious-toxic shock of the ІІ degree is a Disseminated intravascular coaggulopathy-syndrome.

25. Plague bubo, that ruptured

26. Laboratory diagnostics: bacteriological (basic). bacteriological (basic). bacterioscopic (reference). bacterioscopic (reference). serological. serological. biological. biological.

27. Anti-epidemic measures: 1) prevention the import of infection from abroad; 2) making of natural cells of plague healthy; 3) urgent prophylaxis in the case of exposure of patient with a plague.

28. immunization of people : vaccinations of population of certain territories; vaccinations of population of certain territories; urgent 6-daily prophylaxis by streptomycine tetracycline on suspicion of possible infection. urgent 6-daily prophylaxis by streptomycine tetracycline on suspicion of possible infection.