发病数居前五位的病种为肺结核乙型肝炎梅毒丙肝.ppt

发病数居前五位的病种为：肺结核、乙型肝炎、梅毒、丙肝 、痢疾，占发病总数的90.06% 死亡数居前五位的病种为：艾滋病、肺结核、狂犬病、乙型肝炎、丙肝，占死亡总数的91.05%。 卫生部 2009年3月10日,2009年2月全国法定传染病疫情报告 （2009年2月1日零时至2月28日24时）,发病数居前五位的病种为：肺结核、乙型肝炎、麻疹、梅毒、痢疾，占发病总数的88.40% 死亡数居前五位的病种为：艾滋病、肺结核、狂犬病、乙型肝炎、流脑，占死亡总数的88.82%。 卫生部 2008年3月10日,2008年2月全国法定传染病疫情报告 （2008年2月1日零时至2月28日24时）,发病数居前五位的病种为：肺结核、乙型肝炎、梅毒、痢疾、麻疹，占报告发病总数的86.89% 死亡数居前五位的病种为：狂犬病、肺结核、乙型肝炎、艾滋病、流脑，占报告死亡总数的89.58%。 卫生部 2007年3月12日,2007年2月全国法定传染病疫情报告 （2007年2月1日零时至2月28日24时）,2007年与2006年相比,与2006年相比，2007年甲乙类传染病中，呼吸道传染病和血源及性传播传染病报告发病率分别上升3.55%和6.96%。 呼吸道传染病中的猩红热和麻疹上升幅度较大，病例数分别上升了20.61%和8.88%； 血源及性传播传染病中的艾滋病、丙肝和梅毒上升幅度较大，病例数分别上升了45.04%、30.01%和24.09%。 自然疫源及虫媒传染病和肠道传染病报告发病数分别较2006年下降19.20%和9.19%。,Primary Pulmonary Tuberculosis,Three landmark -human control TB Mar,1882 Robert Koch (Germany) Effective chemotherapeutics （1944 SM； 1950 INH） Protocols in Molecular Biology used in TB research,Significant progress in chemotherapy,Greatly improve efficacy, Overview,Tuberculotic current situation AIDS and TB co-infection about 40-50% AIDS and TB Showed adverse effects on each other HIV lead to Potential TB expose and deteriorate TB become an early complication after infected with HIV TB lead to AIDS progression and death Most died of Pneumocystis carinii disease, bacterial pneumonia a few died of TB, Overview,Tuberculotic immunization Cellular immunity Incidence of infection depends on： Amount, flora, toxicum of bacterial Immune function of body Affectability（genetic factor)： Patient with Antigen HLA-Bw35, incidence of TB (relative risk 7.38), TBM (relative risk 15.21), Overview,Classification of TB,primary pulmonary tuberculosis（l型） Hematogenous disseminated pulmonary tuberculosis（ll型） Secondary pulmonary Tuberculosis（lll型） Tuboerculus pleurisy;tuberculous pleuritis（lV型） Extrapulmonary tuberculosis（V型）,Primary Pulmonary Tuberculosis ： one of the most common clinical type in children primary infection Primary Pulmonary Tuberculosis ： Primary Complex Tuberculosis of Bronchial Lymph nodes,Primary complex 原发综合征, primary lesions lymphangitis Lymphadenitis,Tuberculosis of Bronchial Lymph nodes 支气管淋巴结结核 （胸内淋巴结结核） The scope of primary lesions are small or has been absorbed, Pathology,Location: Right-Sided Mostly，Subpleural bottom of lobus superior pulmonis upside of lobus inferior pulmonis basic lesion ： Exudative lesions (渗出) Proliferative lesions (增殖) Caseous necrosis (坏死),Chief Pathology characteristic: Epithelioid cells nodules Langerhans cellular infiltration A high degree of allergy status in child,Extensive inflammatory around lesions The younger, the more obvious large lesions,result,Pathological prognosis 1）Absorption Complete absorption、 Calcification or Scleroma Calcified lesions occur at least 6 to 12 months 2）progression Expand lesions Bronchial lymph fistula Atelectasis、Emphysema Tuberculous pleurisy 3）Deterioration Hematogenous dissemination,、clinical manifestation,()symptom： 1、 fever 2、 Poisoning symptoms of TB anorexia、acratia、Sweating（盗汗） 3、respiratory symptom Little，May have a dry cough Performance in a serious condition： cough，A large number of sputum， hemoptysis，dyspnea,4、Oppression symptom： Oppress Recurrent Laryngeal Nerve Hoarseness Oppress trachea, bronchus Cough, Wheeze（喘鸣）、 Expiratory or Inspiratory obstruction Oppress veins Puffiness of face Oppress phrenic nerve Nausea, vomiting, hiccup,、clinical manifestation,、clinical manifestation,() signs Pulmonary signs: less Extra-pulmonary Signs： Herpes conjunctivitis、Skin erythema nodosum or Multiple one-off arthritis,、diagnose,Significance of early diagnosis () History： Asked in detail about: History of exposure and BCG vaccination, History of infectious diseases Notice nutritional state, immune function () clinical manifestation,() PPD-Test PPD（Protein Purified Derivative） 纯蛋白衍化物 Method：intradermal injections 0.1ml (皮内注射) （含5个结核菌素单位）,、diagnose,() PPD-Test,PPD-Test-positive clinical significance: After BCG vaccination Have been infected with TB Suffering from tuberculosis, there is a new disease activity Clinical cure, TB is not dead From negative to positive or the level of the reaction 20mm， And an increase 6mm, show that there is newly infected,广泛推行BCG接种后， PPD试验的诊断价值 受到一定限制,() PPD-Test,PPD-Test-negative clinical significance： Not infected with TB In pre-allergic stage: after the initial infection 4 8 weeks Immune system hypofunction or temporary interference. (False negative) PPD expired or technical misconduct.,() X-ray examination 1、Primary complex ： Primary lesion、 Cord-like lymphatic vessels Swollen lymph nodes,、diagnose,原发综合症 女，3岁， 初染病灶在右上叶基部，支气管淋巴结肿大,() X-ray examination,2、Tuberculosis of Bronchial Lymph nodes ： Cancer type （nodular type）,左侧支气管淋巴结结核肿瘤型 女，6岁。母有开放性肺TB，病史2年,() X-ray examination,2、Tuberculosis of Bronchial Lymph nodes ： Infiltrating type （Inflammation type）,右侧支气管淋巴结结核浸润型 女，5岁。脑脊液呈典型TBM改变,支气管淋巴结结核伴发淋巴结周围炎,() other auxiliary examination 1、Finding tubercle bacillus in sputum or gastric juice 2、Superficial lymph node biopsy 3、Peripheral blood 4、ESR 5、Flexible bronchofiberscope examination 6、Antibody of TB,、diagnose,、Differential Diagnosis,1、before Chest X-ray inspection URI、tracheitis、rheumatic fever 2、After Chest X-ray inspection pneumonia、bronchiectasis,、treatment,principle：early, combine, appropriate amount, regularity、whole range Untreated TB: at least 10 persons /per 100 persons resistant for a anti-TB drug, there is at least 1 person/per 100 persons resistant for MDR-TB (multi-drug resistant). Re-treated TB (previous accepted anti-TB treatment more than one month): at least 20 persons/per 100 persons of a drug resistance, 7 persons/per 100 persons MDR-TB. course：Short-term therapy general treatment：Rest, Nutrition, regular life,Drug therapy：6HR或9HR， Serious：add on S2月（2SHR/46HR） or Z3月（3HRZ/36HR） Drug Classification：USA Maximum effect，Minimal toxicity eg：INH、RFP Greater effect，Greater toxicity eg：SM、EMB、PZA Minimal effect，Maximum toxicity eg：KM,、treatment