囊尾蚴病.ppt

ScrubTyphus（恙虫病）,1,.,Definition,AcutefebrileinfectiousdiseaseCausedbyRickettsiatsutsugamushiTransmittedbythebiteofchiggersSourceofinfection:RatsCharacterizedbyfever,eschar,rash,andlymphadenopathy,2,Etiology,IntracellularorganismPropagatedinmice,somecellsAntigenicallydiversemicroorganismCommonantigenwithProteusOX-KLowresistance,3,Epidemiology,Sourceofinfection:RatsVector:MiteThelifecycle:ovum,larva,pupa,naiadandimagoOnlyitslarva(chigger)feedingonhumans,4,imago,larva,rat,pupa,naiad,imago,ovum,larva,rat,pupa,naiad,第一代,第二代,(遗传、传染),Thelifecycleofmite,bite,ovum,5,Epidemiology,Proliferateinwarm,wetenvironmentsBothavectorandareservoirRouteoftransmission:biteofchiggerSusceptibility:universalImmunity:long-lastingimmunityagainstthehomologousstrains;Partialimmunityagainsttheotherheterologousstrains,6,Epidemiology,Otherepidemiologicalfeatures:Geographicdistribution:Asian-pacificregionSporadicSeasonaldistribution:rainyseasonsbetweenMayandNovember,7,Pathogenesis,humanbody,rickettsemia,eschar,localsite,rickettsia,mite,vasculitis,rats,8,PathologyBasiclesion:inflammationofthewallsofthesmallbloodvesselsPathologicfindings:eschar,lymphadenopathy,rash,enlargementofspleenandliverSeriouspathologicmanifestations:myocarditis,meningoencephalitis,pneumonia,interstitialnephritis,9,ClinicalmanifestationsIncubationperiod:421daysSuddenonset,Highfever:remittentfeveraccompaniedbychill,headache,malaise,prostration,poorappetite.,10,ClinicalmanifestationsSignsofmultiorgandamage:Meningoencephalitis:delirium,convulsion,coma,andneckstiffness.Interstitialpneumonia:cough,chestpain,breathlessness.,11,ClinicalmanifestationsSignsofmultiorgandamage:Myocarditis:galloprhythm,poorqualityheartsounds,systolicmurmurs.Hepatitis:jaundice,hemorrhage.Naturalcourse:23weeks.,12,CharacteristicmanifestationsEscharandulceration:Characteristicsign.Seenin36.998ofpatients.Generallylocatedinwarm,wet,intensesmelledareas.,13,14,eschar,15,eschar,16,ulceration,17,Characteristicmanifestations2.Lymphadenopathy:Enlargedmarkedlyregionallymphnodesneartheeschar.Generalizedlymphadenopathy.Painful,movable,notpurulent.,18,Characteristicmanifestations3.Rash:Appearsonthe4thtothe6thday.Beginningonthetrunk,spreadtotheextremities.Maculopapular,congestive,noitching.Lasting37days.Seenin35100ofpatients.,19,Characteristicmanifestations4.SplenomegalyandhepatomegalySplenomegaly:3050ofpatients.Hepatomegaly:1020ofpatients.,20,ComplicationsPneumonia,myocarditis,hepatitis,DIC.,21,Diagnosis,EpidemiologicdataHistoryofexposuretoendemicareas.Rainyseason.,22,Diagnosis,2.ClinicalfeaturesAbruptonsetoffever.Accompaniedwithchill,lymphadenopathy,rash,enlargementofspleenandliver.Mostcharacteristicsign:eschar.Therapeuticdiagnosis.,23,Diagnosis,3.LabfindingsA.Routinelabdata:WBCliverenzymevaluesproteinuria.B.SerologicaltestsWeil-Felixreaction,24,Diagnosis,Weil-Felixreaction:Positiveresultobtainedfromthe4thday.Higherthan1:160issuggestive.Availableandinexpensive.About50ofpatientshavediagnostictiters.,25,Diagnosis,Complementfixationtestandindirectimmunofluorescentantibodytest:MoresensitiveandspecificthanWeil-Felixreaction.Fourfoldorgreaterincreaseinconvalescence.Rarelyusedbecauseofthedifficultinpreparingantigens.,26,Diagnosis,C.IsolationoforganismBloodinoculatingintomice.Organismfoundinmononuclearcells.Specifictesttoconfirmthediagnosis.Cantgivearapiddiagnosis.,27,Diagnosis,D.MolecularbiologicassaysNucleicacidhybridizationandPCR.Greatpotentialforsensitiveandspecificdetectionofnucleicacid.Beingevaluated.Limitationoftechniqueandfacilitiesconditions.,28,DifferentialDiagnosis,Otherrickettsialdiseases,typhoidfever,leptospirosis,malaria,dengue,septicemia,influenzaPrognosisFatalityrate:960withouttreatment.5effectivetreatment.,29,Treatment,Chloramphenicol,tetracycline,doxycyclineChloramphenicol:1.52gdaily,dividedinto34aliquots.Feverabateswithin48hours.Totalcourse:1014days.Sideeffects:suppressionofbonemarrowandaplasticanemia.,30,Prevention,Exterminatingthesourceofinfection.Reducingandcontrollingthevectors.Individualprotection:Avoidingcontactwithmites:thebestmethod.,31,Cysticercosis（囊尾蚴病）,DefinitionandintroductionOneofparasiticdiseases.CausedbytheinfectionwiththetissuelarvaeofTaeniasolium.AcquiredbyingestionofTaeniasoliumeggsincontaminatedfoods.Humans:definitehostandintermediatehost.,32,DefinitionandIntroduction,HumaninfectedwithTaeniasoliumintwoforms:intestinalTaeniasoliumandcysticercosis.Cysticercosishasgreaterclinicalsignificance.Cysticercosis:humantissueinfectionwiththeintermediatecystformsofporktapeworm.Cysticercuslocatedinthesubcutaneoustissue,muscle,brain.,33,EtiologyandPathogenesis,Taeniasoliumeggspassedoutfrompatients.Eggstakeninbythefecal-oralroute.Eggsdigestedbygastricjuicetoliberateoncosphere.Oncospherepenetratestheintestinalwallintobloodcirculation.Locatedinsubcutaneoustissue,muscle,brain.Scolexappearsanddevelopsintocysticercus.,34,EtiologyandPathogenesis,Cysticercus:Bladder-like,fluid-filledcyst.Containinganinvaginatedscolex.Surroundedbyfibrouscapsule.Multiple,0.52cminsize.,35,EtiologyandPathogenesis,Cysticercus:Locationinsubcutaneoustissueandskeletalmuscletoproduceminimal,ifany,symptoms;Locationinbraintohaveseriouseffects;Locationinsubstantialtobeabletooccupythespacetoproducetherelevantsign;Locationinventriculitoproducecysticercusracemosus.,36,Epidemiology,Geographicdistribution:LatinAmerica,EastEurope,southeastAsia,Africa.Sourceofinfection:patient.Transmission:fecal-oralroute.Susceptibility:universal.,37,ClinicalManifestation,Dependon2factors:Thelocationandnumberofinfectingcysts;Iftheinflammationexists.Braincysticercosis:foundin6092%ofthetotalcases.Subcutaneousnodule:foundin2/3ofthetotalcases.,38,ClinicalManifestation,BraincysticercosisTheincubationperiod:within5years.CerebralcysticercosisEpilepsy:Causedbycysticercilocatedinthecortexneartothemotorium.Alwaysthefirstandtheonlysymptom.,39,ClinicalManifestation,Epilepsy:Multifocalandunstableseizure.2/3ofthegrandmalbeginwithalocalspasm.Petitmalincludessensoryandmotorialobstruction.,40,ClinicalManifestation,Neurosis:Maybetheonlymanifestationinpatientswithcryptogeniccysticercosis.Intracranialhypertensionsymptoms:vomiting,headache,visualdisturbances.,41,ClinicalManifestation,Ventricularcysticercosis10ofbraincysticercosis.CausedbyacuteobstructionofCSFcirculation.Manifestasthevalvesyndrome(Brunssyndrome)withintermittentpositionalsevereheadache,vomiting,shock.,42,ClinicalManifestation,Subarachnoidcysticercosis10ofbraincysticercosis.Chronic,intermittentmeningitis.3/4haveincreasedintracranialpressure.MixedformMoreseriousneuropsychicsymptoms.,43,ClinicalManifestation,Ocularcysticercosis1.8ofpatientswithcysticercosis.Singleeyeinvolved.Eyepain,decreasingvision,retinaldetachment.,44,ClinicalManifestation,Subcutaneousormusclecysticercosis2/3ofthepatientshavenodules.Numberofnodules:11000.Morefrequentlyfeltonbodyandhead.Generallynosymptoms,45,Diagnosis,Definitivediagnosis:biopsyoftissuecyst.Clinicaldiagnosis:Historyofres