Consultation of the infectious disease doctor: socially significant infections

What are socially significant infections, what are they?

One of the notable infections of the century - viral hepatitis( B and C, in the first place) and HIV infection can be considered as socially significant infections of the XXI century. These are infections with one of the possible ways of transmission - sexual, persisting in the human body in the overwhelming majority of cases for life, and also having the most unfavorable outcome in their dynamic development - lethal.

There is such a thing as "social adaptation" of patients with socially significant infections. It includes an independent awareness of your diagnosis, the realization that you can live with it, the acceptance and adaptation of such patients in society, as well as in the family and close environment of the patient, the absence of fear of infection. All these moments are extremely important for the patient, because the quality of his later life depends on this. Often in society there are certain barriers to such patients. Until now, there is a problem of making a diagnosis in families because of fear of a gap, fear of misunderstanding and unreasonable claims. However, these diseases are not as highly contagious as it is commonly believed, and the knowledge of preventive measures will ensure the quite comfortable existence of patients with their close people, which, of course, will affect the course of the disease for the better.

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Possible ways of infection with infection

Let's recall together the main mechanisms of infection with such infections, not so much for the patients themselves, as for their close environment, so that it is easier to understand the prevention of infection.

Infecting in everyday life is not as easy as it seems at first glance. These infections are classified as gemocontact( that is, infection is possible only through the blood).So, there are two broad groups of transmission ways:

1) Medical( blood transfusion and its preparations, medical manipulations with violation of the integrity of the skin).
2) Non-medical( v / vennoe introduction of drugs, sexual transmission, tattoos and other cosmetic procedures in unsanitary conditions - the lack of special processing tools).

It should not be forgotten that the structure of socially significant infections of the 21st century has undergone changes in the well-being of patients: if diseases were previously registered among socially disadvantaged categories of citizens, now quite well-off socially infected patients are also found who are accidentally infected.

In a home such patients do not need to have personal utensils. It is recommended to have individual personal hygiene items( bast, toothbrush, manicure and shaving accessories, towels).Sexual transmission is more relevant for hepatitis B and HIV infection than hepatitis C. Recommendations of specialists are reduced to the use of barrier means of protection in spouses.

To which doctor should I contact if I suspect an infection, who is in charge of dispensary care?

Every patient with suspected HIV or hepatitis should know that there is a specialist doctor to whom he can apply for free and receive expert advice. This specialist is called infectious disease specialist .Doctors-infectious diseases are taken in all out-patient clinics at the place of residence. If there is no one in any clinic, that is, in the district center. Infectionist is your "trusted doctor".It is here that you can fearlessly tell about all complaints, the duration of the disease, and ask all possible questions. In addition to the initial consultation, this specialist will have your outpatient supervision.

Patients with HIV infection, in addition to local infection clinics, have "trusted doctors" in the regional AIDS Centers across Russia. Here, there are also anonymous infectious disease reception rooms. For patients with HIV, primary counseling is provided in these centers.

Legislative rights: Article 23 of the Constitution of the RF establishes the right of any citizen to inviolability of private property, personal and family secrets. The medical secret( the secret of the diagnosis) is a personal secret. Non-disclosure of medical secrecy is guaranteed by art.30 of the Fundamentals of the RF legislation on the protection of public health and is ensured by the legal responsibility of the doctor.

Why do I need to see a doctor? Purpose and objectives of the visit.

The main purpose of a visit to an infectious disease specialist is to improve the quality and life expectancy. This goal is achieved by solving certain tasks:

1) To make the first visit to the infectious disease doctor of his polyclinic.
2) Complete a complete examination in order to establish a definitive diagnosis.
3) To get on the dispensary account and receive medical recommendations.

Many patients are stopped by one of the frequent questions: "Why should I walk? Nothing
does not bother, it does not hurt. In the end, "you know less, you sleep more tightly".The answer is quite obvious: "This is a deep mistaken error."Any disease, and even more infectious, has its development, that is, it is cyclical. With chronic processes over the years, one stage passes into another. Therefore, a doctor should be visited not for his "check in the magazine", but for his own health and for the prevention of complications.

What are the consequences of chronic hepatitis: the growth of viral load in the blood due to increased multiplication of the virus in the liver and other systems, the development of fibrosis, the formation of cirrhosis, hepatocellular carcinoma( cancer).All these consequences can and should be prevented in a timely manner, for this purpose dispensary dynamic observation by the doctor is necessary.

It is desirable that it is one doctor who knows your entire history, the accompanying pathology and the dynamics of the underlying disease. Clinical follow-up is regulated by certain documents( Order No. 408 "On Measures to Reduce the Incidence of Viral Hepatitis in the Country" of 12.07.89, SanPin 3.1.1.2341-08 "Prevention of Viral Hepatitis B") and is performed every 6 months, and whenpresence of active infection on a quarterly basis. Patients on therapy are invited to the infectious disease specialist monthly.

The consequences of the HIV infection are obvious to many. In the absence of medical care for such patients, the virus begins to multiply actively, significantly affecting human immunity. Observation of such patients carries one goal - the prevention of infectious complications against the background of a persistent decline in immunity, namely, the prevention of the onset of the stage of AIDS.The medical examination and assistance is also regulated by documents( SP 3.1.5.2826-10 "HIV Prevention").Clinical examination of patients with HIV infection is carried out at least once every 6 months, sometimes the patient is invited to visit more often.

What should be prepared for infectious disease reception:

- complaints about complaints;
- collection of epidemiological anamnesis, which is important for diagnosis and preliminary determination of the duration of infection( the doctor can ask about all possible manipulations, sexual relations, procedures, operations, lifestyle) - you need to be ready for this;
- clinical examination( skin, lymph nodes, eye, eyes, lungs and heart, stomach - liver, spleen, intestines);
- referral for additional examination( blood, urine, feces, instrumental research).

What complaints can lead to an infectious disease patient with chronic hepatitis.

More often such patients find in themselves positive analyzes absolutely casually - at planned inspection for operative treatment, at stationary treatment, at passage of medical inspections. Consequently, the vast majority of the newly diagnosed patients do not experience any health changes. However, despite this, you do not need to postpone your visit to a specialist. Patients with suspected chronic hepatitis can complain of weakness, fatigue, sweating, decreased appetite, unpleasant sensations in the liver area from heaviness to aching pain, a period of darkening of the urine in the mornings, a disorder of the stool, a marginal yellowing of the sclera of the eyes.

Symptoms of chronic hepatitis requiring urgent medical attention are the development of jaundice, persistent pain in the liver( right upper quadrant), dark urine in the morning, a rash of hemorrhagic nature on the skin of the trunk and extremities.

What are the symptoms that are suspicious of HIV, require an infectious disease specialist and a survey for the infection:

1) A prolonged temperature for more than one month without an established cause.
2) Stool disorder( diarrhea) for more than one month.
3) Weight reduction more than 10% of the original weight for normal diet.
4) Enlargement of lymph nodes of 2 or more groups more than 1 month.
5) Recurrent pneumonia within 1 year.
6) Recurrent purulent-inflammatory and parasitic diseases.

What kind of examination will patients need?

In case of initial consultation with an infectious disease specialist, the physician determines the amount( number) of the necessary examination for the final diagnosis, for assessing the degree of violation of your health, and also determines the further tactics of treatment and dispensary follow-up.

For the primary diagnosis of viral hepatitis, the following will be required:

- a blood test for general, general urine analysis, biochemistry of blood( bilirin and ammonotransferase-ALT,and according to indications prothrombin index-PTI, amylase serum and others;oncomarker - alfafetoprotein - AFP( for CVG B);
- specific diagnosis of hepatitis B: by ELISA( blood on HBsAg, HBeAg, IgG to HBeAg, IgM and G to HBcorAg);by PCR method( blood on DNA-HBV qualitatively and quantitatively);
- specific diagnosis of hepatitis C: by ELISA( blood on IgM to HCV, IgG( NS3,4,5Ag) to HCV);PCR method( blood on RNA-HCV quantitatively, qualitatively, genotype).
- ultrasound of the abdominal cavity( liver, spleen, pancreas, jelly / bladder)
- Assessment of the degree of fibrosis: laboratory research( fibro / actinitis, fibromax);research by the apparatus "Fibroscan", puncture biopsy of the liver according to indications.

For initial diagnosis of HIV infection, the following is required:

- A blood test for antibodies to HIV by ELISA, followed by a 2-day positive test in the immunoblot. Further, the viral load by the PCR method is quantified( already in the specialized laboratory of the AIDS Center).

When the HIV antibody is detected, a complete examination of the patient is carried out: general blood tests, urine, biochemistry, blood for antibodies to infections( herpetic, cytomegalovirus, toxoplasmosis), specialist consultations( neuropathologist, ENT, oculist, therapist, surgeon, urologist)examination of internal organs, ECG.

All results of the conducted studies are stored in individual patient cards, necessarily in the infectious diseases room, in case of HIV infection - in the safe. That is, only a trusted infectious disease doctor has access to the cards.

Outcomes of socially significant infections without supervision and during dispensary supervision by a doctor.

Many patients often wonder: "Well, what happens if you do not go to the doctor? After all, there is a lot of information on the Internet, even more comments, you can take tests without doctor referral in any paid laboratories? Why waste time and appear in the clinic, where people in the queue are mostly elderly people? "I recall a case from practice when one patient with chronic hepatitis could not find time once in six months to do his health( " Work, work, I am an indispensable employee, without me everything will rise! "Is this familiar to you?).He already appeared with jaundice, while examining revealed significant signs of liver fibrosis. It took stationary therapy, which took 2 weeks of the sick leave and serious parenteral treatment.

There is an unspoken rule: "The less often you appear at the doctor, the more powerful will be the surprise of your illness."Consequences of hepatitis is cirrhosis of the liver( proliferation of connective tissue in the liver tissue, that is, its replacement with a connective tissue), and at some stage this process is already irreversible. Another terrible consequence of hepatitis is liver cancer( more often with chronic hepatitis B), for which it is regularly( annually) checked in the blood oncoprotein-alfa-fetoprotein-AFP in the blood.

The degree of consciousness of an HIV-infected patient also depends on his awareness of the diagnosis, its manifestations and outcomes. Progression of HIV infection with the development of severe immunodeficiency, the appearance of frequent purulent-inflammatory, fungal, viral diseases in the patient, and even more so, the development of the AIDS stage, when the body is unable to fight infection, should discipline the patient. Regular meetings with a doctor, dynamic monitoring of viral load, timely prescription of antiviral therapy has good effectiveness in terms of prognosis of the disease.

Social adaptation in society

In the West, the adaptation in a society of patients with socially significant infections( mainly
is related to HIV infection) is currently at a high level - patients are employed, lead an active lifestyle, available for their state of health, public opinion is not so categorical insuch patients. In our country, most prefer to hide not only their diagnosis, but in general the need for regular visits to the doctor. Employment is carried out on an individual basis and mainly on posts that do not require registration of a medical book. And you can understand patients.

Patients with chronic hepatitis adapt in society somewhat easier. Worked in working order. When applying for work in children's preschool institutions( kindergartens, schools), they can only refuse if there are markers of viral hepatitis A and E, which are transmitted by the fecal-oral route, and other hepatitides can not. In other situations, employment should not be obstructed( if there is no disability in the patient himself).

Prevention of socially significant infections

In family centers of socially significant infections, a survey of all family members is conducted( blood is taken to specific examinations).Patients should have personal items of personal hygiene( manicure and shaving accessories, toothbrushes, scouring pads, hairbrushes, towels and bed linens).They must be decontaminated individually. Avoid any contact in the home with infected blood of the patient( with paresis, abrasions, wounds).Prevention of sexual infection( barrier methods of protection).

In viral hepatitis B, there is a specific prevention( vaccination), which should be subjected to all members of the patient's family.

When detecting markers of hepatitis B and C, only gynecologists, surgeons, dentists, urologists, operating and procedural sisters with disabilities of the integrity of the skin are temporarily suspended from medical work. In other cases, medical workers work in compliance with the rules of personal hygiene( all manipulations are carried out by them in rubber gloves).More detailed in the regulatory documents( (Order No. 408 "On measures to reduce the incidence of viral hepatitis in the country" of 12.07.89, SanPin 3.1.1.2341-08 "Prevention of viral hepatitis B")).In the case of occupational HIV infection, health workers are transferred to posts that do not have direct contact with blood.

The doctor infektsionist Bykova N.I.