第五章 第一节 伤寒与副伤寒课件

Typhoid fever Typhoid fever n n General informationGeneral information uu普遍的毒性感染普遍的毒性感染 uuAn acute, An acute, 危及生命的发热疾病危及生命的发热疾病 uuA A bacterial bacterial illness illness caused caused by by 伤寒沙门菌伤寒沙门菌, , a a 革兰阴性杆菌革兰阴性杆菌 found only in humans.found only in humans. Typhoid fever n n 病原学病原学 uu伤寒沙门菌伤寒沙门菌 uu副伤寒沙门菌副伤寒沙门菌 Ag O Ag O 菌体抗原菌体抗原 Ag H Ag H 鞭毛抗原鞭毛抗原 Ag Vi Ag Vi 多糖毒力抗原多糖毒力抗原 a a 属属 in the in the 肠杆菌科肠杆菌科 Typhoid fever EtiologyEtiology flagellesflagelles somasoma Typhoid fever n n EpidEpide emiologymiology t t Salmonella typhi Salmonella typhi infects only humans. infects only humans. t t Human Human transmission transmission occurs occurs through through 消费消费 of of 被污染的食物或者饮料被污染的食物或者饮料 handled handled by by persons persons 排出的排出的 S S typhityphi from from 粪便粪便 (or (or less less commonly commonly 尿液尿液) ) or or water water from from 被伤寒沙门菌污染的城被伤寒沙门菌污染的城 市污水市污水. . Typhoid fever n n EpidemiologyEpidemiology 暴发暴发 of of 肠炎沙门菌肠炎沙门菌 associated with associated with 全国分全国分 布的布的 ice cream products-Minnesota, ice cream products-Minnesota, 南南 达科他州达科他州, , and Wisconsin, 1994and Wisconsin, 1994 Morbidity and mortality weekly reportMorbidity and mortality weekly report centers for disease control and preventioncenters for disease control and prevention MMWR 43(40):1994 Oct 14MMWR 43(40):1994 Oct 14 Typhoid fever 病理生理学 细菌细菌 淋巴管淋巴管 multiplication multiplication within liver, within liver, 胆道胆道, , 骨髓骨髓 1 1 st st bacteriemia bacteriemia Blood circulation Blood circulation Blood circulationBlood circulation 2 2 nd nd bacteri bacterie emiamia 增殖增殖 穿过肠黏膜上皮穿过肠黏膜上皮 经口感染经口感染 Typhoid fever Physiopathology germsgerms Blood circulationBlood circulation Bile ductBile duct 肠肠 stool 炎症 Typhoid fever n n PhysiopathologyPhysiopathology 单核单核巨噬细胞系统的广泛增生性反应巨噬细胞系统的广泛增生性反应 Typhoid fever n n PhysiopathologyPhysiopathology Typhoid fever n n Electronic microscope: Invasion of the Electronic microscope: Invasion of the 回肠上回肠上 皮细胞皮细胞 Typhoid fever 临床表现 n n Incubation-Incubation-7-23 days7-23 days n n Invasion phase-Invasion phase-1 1 st st week week first progressive first progressive n n phase of disease-phase of disease-2 2nd nd-3 -3rd rd week week 持续发热持续发热, , 腹痛腹痛, , 严重厌食严重厌食, , ALT ALT 平坦的玫瑰疹平坦的玫瑰疹 n n phase of phase of 缓解缓解-3 3rd rd-4 -4th th week week n n phase of phase of 恢复恢复-at the end of the at the end of the 4 4th th week week Typhoid fever Clinical Presentation Typhoid fever Rose spots Typhoid fever Diagnosis n n Blood: Blood: 白细胞减少白细胞减少, , especially especially 嗜酸性粒细胞嗜酸性粒细胞 n n 隔离隔离 of germof germ 血培养血培养 粪便培养粪便培养 n n 血清学血清学 ExaminationExamination Test of Widal Test of Widal antibody anti-O 1:80 antibody anti-O 1:80 antibody anti-H 1:160 antibody anti-H 1:160 Typhoid fever n n ExaminExamin ation of ation of 粪便粪便 by by micro-micro- scopescope Typhoid fever n n Radios A.S.PRadios A.S.P( (腹部腹部 without preparationwithout preparation ) ) 结肠镜检查 Typhoid fever 肠出血肠出血 肠穿孔肠穿孔 OthersOthers complications complications less frequentless frequent 并发症并发症 Typhoid fever n n PrognosisPrognosis uuThe The prognosis prognosis depends depends on on the the 地理区地理区 域域 and its and its 人口统计资料人口统计资料 uuBetween Between 10% 10% and and 20% 20% of of patients patients treated treated with with 抗生素抗生素 have have a a 复发复发 after after 最初的最初的 recoveryrecovery Typhoid fever Treatment n n Medical care: Medical care: uuIsolation of patient Isolation of patient uu消毒消毒 of stoolsof stools n n 监测监测: : uu临床临床 生物学生物学 n n Antibiotic Antibiotic 治疗治疗 n n