2012《传染病学总论》（七年制）课件

State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Introduction of Communicable Diseases,Department of Infectious Diseases, First Affiliated Hospital, School of Medicine,RUAN Bing,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Introduce myself,M.D. & Ph.D RUAN Bing 阮 冰,Professor; Doctoral advisor; Vice-Director of Infectious Diseases Department Office: 87236585; MobileEmail: ,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,1996,2001,2006,2007,Key lab of viral infectious diseases, Ministry of public Health,1956,National Key Discipline of Infectious Diseases,Key Lab of Infectious Diseases, Zhejiang Province,State Key Lab for Diagnosis and Treatment of Infectious Diseases,department of Infectious diseases founded,RAPID DEVELOPMENT AS ROCKET,Key Lab of Infectious Diseases, Ministry of Public Health,2002,Introduce my discipline,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,1956,1956,1997,2006,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,传染病学科人才辈出,学科创始人、原浙医大首任校长王季午教授,现任学科带头人、中国工程院院士李兰娟教授,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,传染病学科教学工作,网络教学 ,双语教学,领先于国内的教材建设 国家精品课程（2006）,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,2008级临床医学三系传染病学大课安排,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Conception,Communicable diseases: caused by various pathogens, transmitted to others, spread in the population Infectious diseases: caused by infection,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Why we learn?,In histry, many pestilences were rampant. plague, cholera, smallpox, influenza, malaria, schistosomiasis, kala-azar,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Why we learn?,Achievements,Controlled and eradicated: smallpox, poliomyelitis, plague, cholera, measles,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Why we learn?,Many diseases are still popular. viral hepatitis, HFRS, infectious diarrhea zoonoses (foot and mouth disease, plague, anthrax, rabies, tuberculosis),State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Why we learn?,Some “old” diseases are re-emerging Tuberculosis Schistosomiasis Cholera Syphilis Measles,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Why we learn?,Some “new” diseases are emerging Pathogens found in some non-infectious diseases Helicobacter pyloyi Pathogens found in some infectious diseases hepatitis C/E, lyme disease, legionellosis New appeared disease AIDS, SARS, human avian influenza, resistant mutants,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Why we learn?,bioterrorism Pathogens may be used as biological weapon (anthrax, plague, smallpox, Ebola),State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Characteristics,Diagnosis,Treatment,Prevention,Communicable diseases,Infection & immunity,Epidemic process,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Infection and immunity,16,Section 1,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Conception of infection,Infection：interaction between pathogen and host Infectious disease：biochemical, physiologic, metabolic and immunologic manifestation of the interaction How infection occur? pathogenic organisms human reactions “opportunistic infection“,environmental factors,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Infection spectrum,Pathogen is eliminated or eradicated Covert infection Overt infection Carrier state Latent infection,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,(1) Pathogen is eliminated or eradicated,Non-specific immunity barrier Specific immunity active immunity passive immunity,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Only make the host producing specific immune response Not having histomorphological damage no symptoms and signs no any biochemical changes only discovered by immunological examinations Pathogens can be eradicated or carried,(2) Covert infection,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Make the host producing specific immune response Having pathological changes Immunity can be consolidated or temporary,(3) Overt infection,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,No clinical manifestation but microorganism excreted Various forms: virus or bacteria carrier convalescent, healthy or incubatory carrier acute or chronic carrier,(4) Carrier state,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Locates the pathogen but can not wipes it out Can latently for a long time Can occurs overt infection What is the different point between latent infection and carrier state ?,(5) latent infection,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,The role of pathogen in the infectious process,Invasiveness Virulence Amount of the pathogen Variability,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Invade directly Leptospira, Filariform larva of Ancylostoma Adhere, colonize and produce enterotoxin Vibrio cholera Promote spread Vi antigen of Salmonella typhi,(1) Invasiveness,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Toxins Exotoxin (Vibrio cholera，Corynebacterium diphtheriae, Clostridium tetani) Endotoxin (S. typhi, Sh. dysentery) Enzymes (Entamoeba histolytica),(2) Virulence,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Positive relation with pathogenicity Least number differ greatly,(3) Quantity of pathogens,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Factors: environmental, drug and hereditary Various forms: pathogenicity variation antigenic variation drug-resistant variation,(4) Variability,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,The role of individual immunity in the infectious process,Non-specific immunity (natural immunity) anatomic barriers, phagocytosis, humoral effects Specific immunity (acquired, adaptive, or postinfection immunity) cell-mediated immunity, humoral immunity,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Epidemic process & influenced factors,30,Section 2,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Essential conditions of epidemic process,Sources of infection Routes of transmission Susceptibility of the population,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Patients measles Persons of covert infection poliomyelitis, epidemic cerebrospinal meningitis Pathogen carriers typhoid fever, bacillary dysentery Infected animals rabies, plague, leptospirosis, scrub typhus,(1) Sources of infection,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Air transmission Water and food transmission Contagious transmission Arthropod-bone transmission (blood-sucking arthropods: mosquito, lice, flea, sandfly, mite, tick) Blood, blood products and body fluid Mother to infant (vertical transmission),(2) Routes of transmission,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,The ratio of susceptible persons decide the crowd susceptibility The crowd susceptibility is relation to periodicity of an epidemic The periodicity of an epidemic may be prevented by artificial active immunization,(3) Susceptibility of the population,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Influenced factors of epidemic process,Natural factors geography; climate; ecology focus of infection zoonosis (plague, leptospirosis, human avian influenza) Social factors social background; economical condition; cultural level; anti-epidemic measures,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Characteristics of communicable diseases,36,Section 3,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Basic characteristics,Pathogens Infectivity Epidemiologic feature Postinfection immunity,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Specific Be found with natural science advancements,(1) Pathogens,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,As main distinction “Infective period”,(2) Infectivity,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Endemic (sporadic occurrence, epidemic, pandemic & epidemic outbreak) Seasonal (distribution in time) Regional (distribution in space) Exotic,(3) Epidemiologic feature,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Specific, active, protective Can transfer to newborns through placenta Lasting time varies with the diseases “Concomitant immunity” (helminthiasis),(4) Postinfection immunity,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,The phase in the development of clinical course,Incubation period Prodromal period Period of apparent manifestation Convalescent period,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Normal distribution (quarantine evidence) Related with: invading quantity of pathogens time of the toxin (bacterial food poisoning) wound location (rabies),(1) Incubation period,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Non-specific headache, fever, fatigue, anorexia, and myalgia Coexist in many infectious diseases Usually persist one to three days even miss (sudden onset),(2) Prodromal period,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Special symptoms and signs presented enough rashes, jaundice, heptomegaly, splenomegaly, meningeal irritation signs Especially in some acute diseases measles & varicella Abortive type poliomyelitis, epidemic encephalitis,(3) Period of apparent manifestation,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Immunity increases to a certain level appetite and physical strength recovered residual pathologic & biochemical change infectivity may persist (convalescent carrier) Relapse & recrudescence the symptoms repeatedly and fever rise again,(4) Convalescent period,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Common symptoms and signs,Fever Rash (eruption) Toxemic symptoms Mononuclear phagocyte system (MPS),State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Three phases effervescence, fastigium, defervescence Fever types sustained remittent intermittent irregular,Fever,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Exanthem and enanthem Appearing, distribution, order, shape Four groups: (a) mocule (d) urticaria,Rash (eruption),State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,A lot of non-specific symptoms fever, fatigue, general malaise, anorexia, headache, myalgia, arthralgia, skeletal pain In severe patients: disturbance of consciousness, delirium, meningeal irritation, toxic encephalopathy, respiratory and circulatory failure (septic shock),Toxemic symptoms,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Liver Spleen Lymph nodes,enlarged,Reactions of MPS,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Diagnosis of communicable diseases,52,Section 4,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Clinical data,Detailed history way of an onset symptoms, accompanied ones Careful physical examination specific signs (rose spot, eschar, Kopliks spots),State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Epidemiological data,Age, occupation, season and district Inoculation history and past history Occurrence in the local or the same unit Family history,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Laboratory data,General laboratory detection Detection of pathogens Immunoassay,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,General laboratory detection,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Detection of pathogens,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Immunoassay,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Treatment of communicable diseases,59,Section 5,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,General and supporting,General therapy Isolation, nursing care and psychologic care Supporting therapy Nutrition, balance of water and electrolytes, Enhancement of immunity by blood and biologic products transfusion,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Anti-pathogenic,Antibiotics Chemical drugs Immune serum preparations,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Symptomatic,Ease patients suffering Reduce his energy consuming Protect the main organs from injury Maintain his functions,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Prevention of communicable diseases,63,Section 6,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Management of the sources of infection,Diagnosis & treatment Isolation of patient & carrier Report disease to CDC,In time,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,The lawful communicable diseases in China,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,丙 类 11种,法定传染病,乙 类 26种,甲 类 2种,鼠疫、霍乱,传染性非典型肺炎、艾滋病、病毒性肝炎、 脊髓灰质炎、人感染高致病性禽流感、麻疹 流行性出血热、狂犬病、流行性乙型脑炎 登革热、炭疽、细菌性和阿米巴性痢疾 肺结核、伤寒和副伤寒、流行性脑脊髓膜炎 百日咳、白喉、新生儿破伤风、猩红热 布鲁氏菌病、淋病、梅毒、钩端螺旋体病 血吸虫病、疟疾 、甲型H1N1流感（09年）,流行性感冒、流行性腮腺炎、风疹、 急性出血性结膜炎、麻风病、 流行性和地方性斑疹伤寒、黑热病、 包虫病、丝虫病，其他感染性腹泻病 手足口病（08年）,中华人民共和国 传染病防治法,其中：SARS， 人感染高致病性禽流感 肺炭疽，甲型H1N1 按照甲类传染病管理,法定传染病分类,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Interruption of the route of transmission,Achievement in: diseases transmitted by food, water and insets parasitic diseases Methods: disinfection, insecticide, hygiene measures,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Protection of susceptible population,Special immunological method active: vaccine, bacterial vaccine, toxoid passive: antitoxin, - globulin, immunoglobulin Non-special immunological method improvement of nutrition physical training,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,The procedure of a childhood program for immunization,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Questions,Reviews,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Pathogen is eliminated or eradicated by hos