结核病总论英文

我国结核病的疫情状况,WHO 93年宣布“全球结核病紧急状态”，98年又重申遏制结核病的行动刻不容缓。全球现有结核病人2000万，其中95在发展中国家，每年还会新发生800-1000万肺结核病，其中75的病人年龄在1550岁。如不控制，今后10年还将有9000万人发病。中国是全球22个结核病高负担国家之一，结核病人数位居世界第二位，仅次于印度.据调查全国三分之一的人口已感染了结核菌；受感染人数超过4亿,受结核感染人群中有10的人发生结核病,1,tuberculosis,factor of tuberculosis incidence rising ：HIV spread.TB strain occur drug resistance .fluid population increasing.Management TB patient not perfect、prevention and cure not efficiency.Poverty、population increasing.,2,etiology,Mycobacterium 、 Acid fastness、G+、aerobe。Growth torpidity , culture need 4-6 weeks.Typing : human type 、 bovine type 、 Bird type、mouse type 、 main human type。way of infection：respiration tract、digestive track、skin or placenta.,3,Epidemiology,1 infection sources：open pulmonary tuberculosis2 route of transmission: by respiration way or digestion tract.3 susceptible population,4,Epidemiology,The factors lead Children ill with TBContact TB amounts and toxicity.power of resistance .hereditary factor .,5,pathogenesy,bacterial number、toxicity、immunization conditionCell-mediated immune reaction:macrophage swallow TBantigen presentation Th and macrophageIL12CD+4TH1-IF-to promote mononuclear cell; to gather、activation、proliferation and differentiationto produce alexin and oxidase 、 digestive enzymeto kill TB,6,pathogenesy,IF-reinforcement CD+8 、NK cells activity to phagocytosis TB. meanwhile to lead histoclasiadelayed allergy : T cell media，macrophage to be effector cell，to kill reinfection TB and cause cheesy necrosis or hole formationAfter Infection TB : primary disease（5%），Secondary disease （5%）, not to fall ill all live(90%),7,diagnose,Objectiveto discover focal 。Definite disease character、size whether or not deliver bacterium。,8,diagnose,1 historyTB toxic symptomto contact TB patientBCG vaccinationacute infection:measles，pertussisSupersensitivity erythema nodosum、exanthematous conjunctivitis。,9,diagnose,2 ：OT test agent：1/2000 or 1/10000 PPDdose：0.1ML（OT 5U）（or 1U）。position：left forearm palmaris below 1/3Infuse intracutaneous form 6-10mm hillock。4872hr observation reaction。,10,diagnosis,reaction5mm(-)5mm(+)10-19mm(+)20mm(+)Super reaction :induration、vesic 、 local ulceration (+)。,11,diagnosis,significancepositive reactionAfter BCG vaccinationOlder children positive reaction indicate to be ever infected with TB before。Infant never BCG vaccination indicate new infection recent。Strong positive reaction indicate there is activeness TB.。from（-）to（+）、from 10mm ,or increase 6mm by activeness TB.。,12,diagnosis,negative reactionnever infection TB first Infect TB during 4-8 weeks false negative reaction，immune function to be pressed down。Wrong with test or PPD ineffective,13,diagnosis,BCG Vaccination and natural infection positive reaction condition,14,diagnosis,3 ： laboratory examination（1）find TB specimen：sputum、gastric juice、C.S.F、serous cavity liquid.method：smear、 fluorescent staining、BACTEC system：culture for 2 weeks，test mycobacteria metabolism production，to distinguish TB and atypical .mycobacteria.L tubercle bacterium：mutation TB，form、construction、acid-fast staining different from common TB。Easy passing placenta，therapeutic inefficacy。,15,diagnosis,（2）immunology and molecular biology testELISA（酶联免疫吸附试验）ELIEP（酶联免疫电泳技术）DNA探针PCR （聚合酶链式反应）线条DNA探针杂交试验ESR (血沉)。,16,diagnosis,4 ： chest X-RAYTo definite focus of infection position 、extent、category、activity condition。To evaluate and follow up therapeutic efficacy 。CT more clear to find the focus、 extent and spread condition。5：bronchofiberscopy check：to definite Endotracheal membrane TB and tuberculosis of trachebronchial lymph nodes。6：lymph node puncture smear or lymphaden biopsy to diagnosis。,17,tuberculotherapy,general treatmentnutrition、to take a rest。 avoiding to contact infection disease 。Primarily TB treatment in out-patient clinic and regularity return visit 。Report epidemic situation。,18,tuberculotherapy,Treatmen targetTo kill Bacillus tuberculosis in focusto prevent disseminate。therapeutic principleearly treatmentReasonable dosageCombine medicineRegularity take drugto insist on whole courseSegmenting treatment.,19,tuberculotherapy,Anti-tuberculosis drugsWhole germicide：in acid and alkali，exterior and interior of cell can kill germ。(INH RFP)Half germicide：in acid or alkali environment kill cell interior or exterior TB，SM /PZAbacteriostatic：EMB（ethambutol) ETH(ethionamide),20,tuberculotherapy,new antituberculosis to Anti drug resistant Rifamate(contain INH 150mg RFP300mg)Rifater(INH,RFP PZA) old drug derivant：RifapentineNew chemicals：Dipasic，to delay resistant INH drugstandard treatment：refer to asymptomatic primarily pulmonary tuberculosisusage：INH+RFPEMBcourse of treatment 912 month.,21,化疗方案,Two stage therapyrefer to：activeness primarily pulmonary TB: acute miliary tuberculosis;brain TB;intensification therapy：（purpose）Combination 34 germicide drugsLonger 34mo、shorter 2mo。continue treatment stageCombination two drugs to keep therapeutic effect for 1218mo.(longer rang)or 4mo. (Short-rang) 。,22,化疗方案,short-range therapyWHO important strategy to cure tuberculosis mechanism of action is fast kill organism inner cell or out cell。To sputum bacterium(-)，recovery fast ，recurrence less。2HRZ/4HR、2SHRZ/4HR、2EHRZ/4HR,23,antituberculosis drugs,medicine dose adverse reaction INH 1020 多发性神经炎，肝损害RFP 1015 可逆性肝损害，消化道症状。尿红色。PZA 20-30 肝损害，高尿酸血症。SM 1520 听神经损害,肾损害。EMB 1520 球后视神经炎。,24,Tuberculosis prevention,to control source of infection：smear(+) patientPervasion BCG vaccination：to have an inoculation age is neonate.contraindicationcellular immunity deficiencyacute infectious disease convalescence stageRegion eczema or general skin diseaseOT（+）,25,Tuberculosis prevention,Drug prevention indication:1 Close to contact open pulmonary tuberculosis in family 2 lower 3 years infant have not innoculation BCG; but OT（+）3 OT from（-）to （+）recently4 OT(+) with toxic symptom5 OT（+）and recently ill with measles or pertussis6 OT（+）need long-term to take corticosteroids or immunodepressant,26,Tuberculosis prevention,Approach 1 : INH 10mg/kg course of treatment 69mo.Approach 2 : INH+RFP(10mg/kg) course 3 mo.,27,原发性肺结核（primary pulmonary tuberculosis),首次侵入肺部发生的原发感染原发综合症（primary complex)原发病灶+局部病变淋巴结+淋巴管支气管淋巴结结核(胸腔内肿大淋巴结结核),28,primary pulmonary tuberculosis,病理部位:右侧肺上叶底部、下叶上部基本病变：渗出（炎症细胞 单核细胞 纤维蛋白）、增殖（结核结节 结核肉芽肿）、坏死（干酪样坏死）。炎症特征：上皮