Chronic non-specific and specific infection. AIDS

1. Chronic non-specific and specific infection. AIDS m.d. Shydlovscky. A.V.

2. SPECIFIC TYPES OF CHRONIC INFECTION tuberculosis syphilis actinomycosis

3. Tuberculosis Tuberculosis is a chronic disease has an undulating character. The world is now experiencing a new, another attack of this disease.          In Ukraine the situation is related to the spread of tuberculosis began to deteriorate in 1990, and in 1995 recorded an epidemic of progressive disease. Annual medical and economic losses from tuberculosis in Ukraine are1,49 млрд. грн.

4. Tuberculosis in the facts Tuberculosis - an infectious disease that usually attacks the lungs Transmitted via droplets from people with active phase of the disease Symptoms of active TB - cough, weight loss, chest pain, fever and night sweating Tuberculosis is treated with a course of antibiotics Ukraine - one of 27 countries where tuberculosis detected with resistance to first-line drugs - isoniazid and rifampicin Ukraine - one of the 18 European countries where the disease is 8 times higher than average and is 73 persons per 100 thousand population Tuberculosis

5. Head of the Parliamentary Committee on Health Tatiana Bakhteeva State Economic losses from this infection exceeding 3 billion. According to the criteria of the European Office of WHO, Ukraine has the second highest incidence of tuberculosis in Europe (after Russia), and 4 in the world for its prevalence. Ukraine is one of the 27 countries in which concentrated 85% of the total burden of MDR TB. Today we have the total number of new patients with TB is about 9 thousand a year, which indicates that the country's epidemic is rapidly spreading. Tuberculosis

6. Tuberculosis(Clinical forms) Respiratory Osteo – articular Urogenital The nervous system and brain Intestines, peritoneum and lymph nodes Skin and subcutaneous tissue The organs of sight and hearing

7. Osteoarticular tuberculosis • Up to 20% of all clinical forms tbc; • This is a local manifestation of tbc process; • Hematogenous route of infection. • The most sensitive tissue is rich in bone marrow:         • vertebrae         • - Epiphysis of long tubular bones         • - Spongy bone         • - Diaphysis of long bones (less)

8. CLINICAL PHASE tuberculosis of bones • Prearthrytyc (primary osteitis)  • arthritic (secondary arthritis and its three phases:               • the beginning               • - height               • - remission  • • Postarthrytyc (the effects of arthritis, acute, recurrent)

9. Tuberculosis of the spine(SPONDILITIS) • Makes up 40% of the number of patients with osteo-articular tbc; • Location:           • Thoracic - 60%;           - Lumbar - 30 - 35%;           - Sacral - 5 - 10%    • Amazed least 2 vertebrae, and the children - 3 or more (up to six)

10. The clinical picture(PRESPONDYLITYC PHASE) • Hospital vague, not clear, not specific:       • Malaise, weakness       - slimming       - Loss of appetite       - Indefinite pain in the spine       - Limiting the amplitude of the bending motion • radiological determined by fire destruction of vertebrae

11. The clinical picture(SPONDYLITYC PHASE) • Severe clinical picture:     - Intoxication, fatigue, weight loss;     - Pain in the spine (mainly well-localized)     - Increased pain with a load on the spine     - Symptom "vizhok"     - A symptom of "sword"     - Curvature of the spine to form a hump     - Formation of wandering abscess (rare)

12. Reducing the height of the intervertebral disc; Destruction of bone lesions with the presence of sequestra and irregular contours; Compression fractures; Angular curvature of the spine (hump); Wandering abscess (80%). Radiological signs Tuberculous spondylitis X, XI thoracic vertebrae. It is evident vertebral deformity and abscess

13. Regression of clinical symptoms; Functional thickening of the vertebrae below the lesion; Possible exacerbation and relapse; Restitution anatomical changes and restore function does not occur The clinical picture (POSTSPONDYLITYC PHASE)

14. Accounted for 20% of cases of osteo-articular tuberculosis; • Over the course is divided into phases: - prearthrytyc - arthritic - postarthrytyc KNEE JOINT TUBERCULOSIS (gonitis)

15. Local lesions: • Proximal tibia - 80%; • - Distal femur - 22%; • - Metaphysis of bones - up to 10%; • - Rarely – patella • Clinic - intoxication and indefinite pain in the joint. • X-ray - osteoporosis bone foci of destruction. CLINIC(prearthrytyc phase)

16. Joint pain at rest Local redness and swelling of the joint Atrophy of muscles flexion contracture The increase in the volume of joint Wandering abscess, fistula Subluxation leg (usually backwards) arthritic PHASE

17. Joint space narrowing Inequality contours of the articular surfaces The centers of regional destruction of bones that form the joint Having sequestration X-ray picture of gonitis Tuberculous gonitis with a fireplace in the epiphysis of the femur

18. Hospital reduces developing ankylosis Fibrotic fusion Pathological extremity fixation subluxation of the tibia Recurrence and exacerbation Postarthrytyc phase

19. It occupies about 20% of all bone TBC. About 60% of sick children Clinic • • Periodic and later permanent lameness • • Common symptoms of intoxication • • Steady local pain • • The gradual restriction of movement • • Pathological fixation in joint pain flexion contracture • • Over time, constant pain Tuberculosis of hip(coxitis)

20. Bone osteoporosis (early symptom) After 1 - 1.5 months. from the onset of degradation of the femur firewandering abscess Joint space narrowing The centers of regional destruction of bone tissue In the area of ​​bone sclerosis lesions (postarthrytyc phase) Osteoporosis, ankylosis Radiographic changes in coxitis

21. Up to 4% of patients with bone tbc • Age Adults (15 to 40)Weakness in the hand • Pain in the joints • Atrophy of the muscles, especially deltoid • Restriction of movement • X-ray picture of osteitis, bone osteoporosis later • Marginal source of destruction of the articular surfaces • Sometimes formed sequesters • Sometimes radiographic changes the type of "dry caries“ • Regional uzuration of humerus epiphysis with multiple sclerosis • Joint space narrowing • Absence of exudation and effusion • Shrinkage of the joint capsule • Severe muscle atrophy. • In postarthrytyc phase formed osteoarthritis, tendency to relapse Tuberculosis of the shoulder joint(omarthritis)

22. Frequency 2.3 - 2.6% of patients with bone tbc The weakness of the hands, dull pain in the joint during movement Limitation of movement Joint swelling and muscle atrophy More often strike metaphysis shoulder and elbow bones X-ray changes of periosteum, osteoporosis Craiova destruction of bone formation sequestration Frequently wandering abscess and fistula Postarthrytyc phase ends by ankylosis Tuberculosis of the elbow joint(olenitis)

23. Overall antibiotic therapy  Orthopedic treatment: unloading and immobilization (plaster bed, corset splints)  Surgical treatment Radical (stabilizing, restorative, preventive, decompressive) operations Palliative surgery  Spa treatment with restorative physiotherapy (Evpatoria) Treatment of bone tbc

24. Over the past year, compared to 2008, the incidence of syphilis in the Ternopil region increased by as much as 30 percent! One hundred thousand people to 15 people suffer from it and it's a lot. Of course, in the early 90s, the figure was much higher - 900. (Ternopil skins. Ven. Dispensary, O.I.Hara) Syphilis

25. Classification (born, tertiary) Bone lesions from 40 to 95% Changes in bone is often the only symptom that indicates syphilis Syphilis

26. Specific areas of bone destruction syphilis Epiphyseal cartilage discs that provide growth of long bones Cambial layer of the periosteum, which provides bone growth in thickness• Thus, specific changes in bone syphilis is osteochondritis in the epiphysis of long bones and syphilitic peryostitis in the diaphysis Congenital syphilis Syphilitic periostitis and osteochondritis Syphilitic osteochondritis

27. Surface are affected by long tubular bones (forearm, leg, bones, nose, hard palate) Developed through years after infection Serological response in half of the negative cases Liquid damage vertebral joints Tertiary syphilis

28. Actinomycosis - a chronic purulent uncontagiosedisease caused by a number of luminous fungi Actinomycetales, affects people in middle age, lasts for years, and has significant medical, social and economic losses. Visceral localization among the totality of patients make up 20% lesion face and neck - about 80%.  This fungus - saprophyte Actinomycosis

29. Actinomycosis head Tongue and neck Thoracic Abdominalurinary tractadrectal Skin Central Nervous System Clinical forms of actinomycosis

30. Thick not pain infiltration of the skin Subsequently, the skin over it purplish-cyanotic appears fluctuations Opens fistula with purulent discharge which is whitish druse fungus Stage of disease: infiltrative, abscessed, fistulas, CLINIC(common symptoms)

31. Ranked first among all lesions (80%) Affects the cheeks, tongue, lips, tonsils, trachea, larynx Actinomycosis face

32. The defeat of the bronchi, lungs, pleura General weakness, shortness of breath Coughing up sputum with the smell of earth and copper Low-grade constant temperature Further development perybronchitis, the transition process in the chest wall to form a fistula communicating with bronchi Flow heavy mortality to 50% Thoracic actinomycosis

33. Preferably fistula in the ileo-cecal area In clinical mimics acute surgical diseases Spreading captures other organs (liver, pancreas, kidneys) Fistula with intestinal secretions Without treatment, long course, the transition process to other organs - fatal consequence Abdominal actinomycosis

34. Fenoksymetylpenitsylin 2 g / day and the duration of the course for at least 6 weeks. Tetracycline 0.75 December 4 times a day four weeks     or 3 grams a day only in the first 10 days and then 0.5 g 4 times a day for the next 18 days  Erythromycin 0.3 December 4 times a day six weeks Treatment of actinomycosis

35. Benzylpenicillin (10 million units / day or more) intravenously for 1 - 1.5 months with subsequent transition to fenoksymetylpenitsylin a daily dose of 2-5 g for 2-5 months. Surgical expedient in bulk For immunotherapy aktynolizat - 3 ml intramuscularly aktynolizata 2 times a week. At the rate - 20-30 injections, duration of 3 months Treatment of actinomycosis

36. Number of people living with HIV: 440 000 (340 000 - 540 000) Prevalence among adults aged 15-49 years: 1.6% (1.2% - 2%) Adults aged 15 and over living with HIV: 430 000 (330 000 - 530 000) Women aged 15 years and older living with HIV: 190 000 (140 000 - 230 000) Deaths by AIDS: 19,000 (14,000 - 25,000) HIV / AIDS in Ukraine

37. AIDS in surgery Acquired Immune Deficiency Syndrome (AIDS) is the most dangerous infectious disease, leading to death after an average of 10-11 years after infection with human immunodeficiency virus (HIV). The disease has already claimed the lives of more than 18 million people today living in the world 34.3 million HIV-infected people. Typical morphological target HIV

38. Clinical examples of AIDS Necrosis of the soft tissues of the mouth angle of the background herpes in HIV - infected children

39. Clinical examples of AIDS Giant left foot Kaposi's sarcoma

40. Clinical examples of AIDS Kaposi's sarcoma of the eye and orbit in stage collapse

41. The main face of AIDS in surgery is the prevention of HIV infection nursing It is mandatory the use of gloves, aprons (when dealing with blood and tissues) In procedural and dressing rooms of kits should be the means of HIV prevention AIDS in surgery

42. Ingredients kit The solution marhantsovky A solution of 5% iodine A solution of 30% albutsida or 1% silver nitrate The solution protargola70% alcohol AIDS in surgery

43. Operative field is prepared using a single device for shaving Do not allow staff to work with damaged skin To protect the participants during the operation to apply aprons, shoe covers, sleeves, disposable gowns (all of nonwoven materials), goggles, double mask on the nose, the hands two pairs of latex gloves Prophylaxis before and during surgery

44. Use tools only for AIDS patients Cutting and piercing instruments surgeon is very Carefully, without haste operate After surgery, special treatment just tools, used Special processing operating Organisation and operation

45. Ligation and manipulation in specially equipped and only for such patients rooms Staff dressed as an operation Use only marked tools After ligation treatment tool room and everything used - like after surgery After the operation

46. When puncture gloves - replacement of the skin after treatment 70% alcohol When injected fluid to the skin - treatment for 2 min 70% alcohol, wash with soap and water, repeated treatment with alcohol With cuts and punctures the skin - squeeze 2-3 drops of blood and process 5% iodine AM When injected into the eye - wash with water and drip silver nitrate Preventive measures