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THEME OF THE LESSON:

ORNITHOSIS. QUERY FEVER
(Q-fever, pneumorckettsiosis)

Ornithosis
The activator: Chlamydia ornithosis, the sizes of a microorganism change
from 400 up to 1200 nm. Average duration of development is of 40-48 hours. In an
environment it is kept about 2-3 weeks. It is inactivated by at heating higher than 70°С
and under influence of disinfectant substances (chloramine, Lysol, ether, formalin).
The source of an infection: domestic and wild birds.
The mechanism of infection: aerogenic and fecal-oral.
Ways of transfer: airborne, contact, contact-professional, alimentary.
Patients with ornithosis danger to associates do not represent.

Clinic.
The incubatory period is from 6 about 17 days. Disease sharply begins from
fever, rise in temperature of a body up to 39°C, a headache, pains in muscles of a back
and extremities, weakness, adynamia accrues, appetite is reduced.
The clinical picture of ornithosis is polymorphic and depends on the form and
severity of the disease. So at the typical pneumonic form to above enumerated
symptoms signs of lesion of organs of breath join. The most frequently there are
observed: dry cough with difficultly separated sputum, lacinating pains in a chest,
shortening of a percutour sound, weakening of breath, sonorous small-bubbling rales
above the damaged site of lungs. Rather frequently by the end of the first week of the
disease it is registered hepatolienal syndrome. Radiologically lesion of the bottom
shares (VIII, IX, X) as the small focuses of infiltration, parenchymatous or interstitial
changes is more often revealed. At favorable current duration of a cycle of the disease
does not exceed one month and comes to an end by recovery. However in 10-15 % of
cases chronic forms of ornithosis are developed; they can proceed 5 and more years,
carry flabby-coursing character with change of aggravations and remissions. Except
for typical forms atypical forms are registered: ornithosic meningitis, acute ornithosis
without lesion of lungs, meningopneumonia.
Complications: thrombophlebitises, hepatitises, pancreatitis, myocarditises,
iridocyclitises, thyroiditises.
Laboratory diagnostics
Serological research: reactions of fixation of complement (CFR) and reaction
of inhibition of hemagglutination (RIHA) with ornithosic diagnosticum. Diagnostic
titer in CFR is 1/16-1/32, for RIHA - 1:512 and more.
Treatment will be carried out by preparations of tetraxyxlinic group
(Tetracycline 1,2-2,0 g per day depending on severity of process).
Hospitalization is under clinical indications.
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Isolation of contact will not be carried out.
The extract is on clinical recovery.

REALIZATION ЗЯНЯТИЯ
The purpose is to learn to diagnose ornithosis according to clinic, the
epidemiological anamnesis and also to make the plan of inspection and treatment.
Control questions to the beginning of the lesson
1. Etiology of ornithosis.
2. Name a source of infection.
3. Enumerate ways of transfer at ornithosis.
4. Name clinical forms of ornithosis.
5. Name complications which can be observed at ornithosis.
6. What methods of laboratory diagnostics are used at ornithosis?
7. What are principles of treatment ornithosis?

The test
1. Pathogenetic mechanisms of ornithosis are:
1. Penetration of the activator through an epithelium of mucous membranes of
respiratory ways
2. Duplication and accumulation in epithelial, lymphoid and reticulo-histiocytic
cells
3. Development of intoxication and sensitization of an organism
4. Hematogenic dissemination of the activator
5. Development of inflammatory processes in organs
2. Features of current of pneumonia at ornithosis are:
1. Expressed dyspnea
2. Signs of tracheobronchitis.
3. Slow resorption of the focuses of a pneumonia
4. The poor physical data
5. Moist rales, mainly above the lower departments of lungs
3. The radiological characteristic of ornithosic pneumonia is:
1. Interstitial changes or the focuses of infiltrates
2. Localizaation of infiltrates mainly in the lower departments of lungs
3. Expansion of pulmonary roots
4. Amplification of bronchovascular figure
5. Increase of radicial lymphatic nodes
4. Clinical signs of the generalized form of ornithosis are:
1. Fever
2. Arthralgias in large joints
3. Paleness of integuments, conjunctivitis, episcleritis
4. Hepatosplenomegalia
5. Splenomegalia
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5. Serological reactions for diagnostics of ornithosis are:
1. RIHA
2. Vidal’s reaction
3. Rajt’s reaction
4. CFR
5. Reaction of Hoff-Bauer.
7. Methods of treatment of patients with ornithosis are:
1. Broncholytics
2. Macrolids
3. Hemodialysis
4. Oxigenotherapy
5. Vitamins
7. Preparations for etiological therapy are:
1. Penicillin
2. Azytromycinum
3. Erythromycinum
4. Streptomycin.
5. Doxicyclinum

For discussion of a theme of the lesson students study a clinical problem. At

the decision of problems students write in writing-books the clinical diagnosis in view
of the form and severity of the disease, the plan of laboratory-instrumental inspection
of the patient, the plan of treatment with reception in Latin language of preparations
of antibacterial and pathogenetic action.

PROBLEM
Patient E., 45 years, the poultry-mail, has entered in infectious branch on the
th
6 day of the disease.
She complaints to pains in a lumbar area and in a chest, a headache, bad
appetite, strong cough, muscular pains.
The history of the disease: she was ill sharply 25/IX, the temperature with a
fever has risen up to 38,1-38,8°C, the headache and a pain in a chest which were kept
all 6 days of the disease have appeared. Since the second day of the disease the patient
accepted Laevomycetonum within 3 days. The condition was not improved. The
doctor has directed the patient to hospital with the diagnosis “feverish condition”.
Epidemiological: in family there was no the diseased. The patient works on a
poultry farm.
The objective data: an average condition. Temperature is 38,4°C, a face is
hyperemic. In lungs there is vesicular breath. Tones of a heart are clean. Pulse is 60 in
one minute; the arterial pressure is 95/55 m.Hg. A tongue is imposed with a white
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membrane. A spleen is palpated. At radioscopy of lungs in the right radical zone
infiltration is defined.
The analysis of blood: leukocytes - 4000, eosinophiles - 2 %, rodonuclear - 6
%, segmented - 52 %, lymphocytes - 32 %, monocytes - 8 %, RSE - 38 mm / hour.

1. The prospective clinical diagnosis.

2. With what diseases is it necessary to carry out differential diagnostics?
3. Make the plan of inspection.
4. Make the plan of treatment.
5. Write out in Latin language the basic medical preparations of etiological and
pathogenetic action.

Q -fever
The activator: Bernett’s rickettsia (Coxiella burneti). It is differed by high
stability in an environment, long kept in meat, milk. It is enough of one rickettsia for
infection of the person.
The source (and the reservoir) of infection: wild animals and pets, birds and
arthropods (ticks). Mechanisms of infection and a way of transmission of infection are
various: alimentary, water, airborne, contact, transmissive. Factors of transmission are
milk, meat, water, skins, wool, straw, air with dust particles. The persons borrowed
with agricultural works and processing of animal raw material fall ill more often. The
person is not a source of infection, but cases of infection of newborns from mothers
through milk are known.
Clinic
The incubatory period is from 3 about 32 days. Disease begins sharply from
fever, rise in temperature up to 39 - 40°С, a headache, pains in muscles and joints,
eyeballs, disturbances of dream (neurotoxicosis, as at pulmonary forms of another
rickettsiosis - typhus). Hyperemia and puffiness of a face, a neck, an injection of
vessels of scleras, hepatomegalia are characteristic. It is occasionally observed
poseolous or roseolous-papular exanthema, exanthema. In half of cases Q-fever is
accompanied by neumonia with the poor data of auscultation and moderate focal
changes at radiological research. The clinical picture is rather various (the name of
disease occurs from a word “unknown”), alongside with heavy forms easy, erased and
asymptomatic can be observed.
At typical current the disease comes to an end for 2-3 weeks. At a part of
patients long (within 2-3 months) and chronic (from 3 months about one year and
more) current is marked. The long form is accompanied by torpid current pneumonia
or myocarditis, subfebrility. At chronic current of pneumonia, myo-and endocarditises
with frequent aggravations, asthenisation are observed.
Complications: in the acute period - serous meningitis, encephalitis; in
prolonged and chronic – lesions of lungs, a heart.
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Laboratory diagnostics
Serological research: reaction of agglutination and CFR with an antigen from
Bernett’s rickettsias. A diagnostic titer in reaction of agglutination is 1:8, in CFR -
1:80 under condition of its increase in dynamics to 4-5th week of the disease.
Treatment will be carried out with application of tetracyclins (Doxicyclinum on
0,1 g 2 times per day during 8-10 days), it is possible to use ftorchinolons,
Laevomycetinum, Rifampycimun
Hospitalization is under clinical indications.
Isolation of the contact will not be carried out.
Extract - on clinical recovery.

REALIZATION THE LESSON

The purpose is to learn to diagnose Q-fever according to clinic, the
epidemiological anamnesis and also to make the plan of inspection and treatment.
Control questions to the beginning of the lesson
1. Etiology of Q-fever.
2. Name a source of infection.
3. Enumerate ways of transfer at Q-fever.
4. Name clinical forms of Q-fever.
5. Name complications which can be observed at Q-fever.
6. What methods of laboratory diagnostics are used at Q-fever?
7. With what diseases is it necessary to differentiate Q-fever?
8. What are principles of treatment of Q-fever?

The test
1. The basic phases of pathogenesis are:
1. Introduction of the activator in respiratory ways, a gastroinrestinal tract or
integuments
2. Lymphogenic and hematogenic dissemination in parenchymatous organs
3. Formation of the focuses of proliferation of reticuloendothelium,
perivasculitises, necrobiosis of cells.
4. Development of infiltrative process in lungs.
5. Formation of immunity.
2. Clinical symptoms of an initial stage of the disease are:
1. Acute beginning with high fever and chill.
2. Headaches with retrobulbar localization, myalgias, arthralgias.
3. Hyperemia of a face and a neck, an injection of vessels of scleras.
4. Symptoms of “socks” and “gloves”.
5. Absence of the physical data by the side of lungs.
3. Clinical signs of the period of heat are:
1. Long high fever and other signs of intoxication.
2. Relative bradycardia, arterial hypotension, dullness of tones of a heart.
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3. Symptoms of tracheitis and bronchitis.
4. Clinical and radiological signs of interstitial preradicial pneumonia.
5. Hepatolienal syndrome.
4. Atypical current of the disease is:
1. Grippe-liked
2. Pseudobrucellous
3. Pseudotoberculous
4. Septic
5. Cholera-liked
5. Methods of laboratory diagnostics of Q-fever are:
1. Bacteriological research of blood.
2. CFR
3. RA and RIHA
4. Reaction of neutralization of toxin.
5. Bacterioscopy of smear of blood.
6. Complications of Q-fever are:
1. Endocarditis
2. Pleurisy
3. Pyelonephritis
4. Meningoencephalitis
5. Expressed dehydration
7. Methods of treatment in acute phase of the disease:
1. Etiological therapy
2. Vaccinotherapy
3. Desintoxicational therapy
4. Rehydration
5. Physiotherapeutic treatment.

For discussion of a theme of the lesson students study a clinical problem. At

the decision of problems students write in writing-books the clinical diagnosis in view
of the form and severity of the disease, the plan of laboratory-instrumental inspection
of the patient, the plan of treatment with writing out in Latin language of preparations
of antibacterial and pathogenetic action.