Epidemic Encephalitis BDept. Of Infectious Disease[流行性乙型脑炎BDept传染病](PPT-41).ppt

epidemicencephalitisb dept ofinfectiousdiseaseshengjinghospitalcmu definition epidemicencephalitisbisacuteinfectiousdiseasecausedbyencephalitisbvirus usuallyoccursinsummer fall thevirusistransmittedbymosquito pathologiclesions cerebralparenchymaclinicalfeature highfeveralteredconsciousnessconvulsionmeningealirritationrespiratoryfailure etiology causativeagent encephalitisbvirusgenusflavivirusofflaviviridaesinglestrainofpositive senserna virionisspheric diameter 15 22nm resistance unstableinenvironment sensitivetoheat disinfectants ultravioletrays etiology antigenicity stablehemagglutinationinhibitingabcomplementfixingabneutralizingab epidemiology sourceofinfectiondomesticanimals pig horse dogpoultry chicken duck goose patients epidemiology routeoftransmissioninsectborne mosquitobiting vector mosquito culextritaeniorhynchus survivedwintermosquitoespigsmosquitoesmosquitoespersonpigs epidemiology susceptibilityofpopulation universalsusceptiblelifelongimmunitysubclinicalinfection overtinfection1000 2000 1 epidemiology epidemiologicfeaturessporadicfromjulytosep childrenunder10yrs 2 6yrs hypersporadicproperty pathogenesis virus mosquitobiting replicationinmononuclear phagocytesystem mps onsetofillness cns bloodstream blood brainbarrier briefviremia subclinicalinf clearance no ofvirusofinvasioncellularimmunitybloodbrainbarrier pathology placeoflesion allofcnscerebralcortex midbrainandthalamus pathologicfeaturesgrossexamination congestionhemorrhagecerebraledemasoftenfocuses pathology microscopicexamination vascularlesion endothelialcellsswelling necrosisneurondegeneration necrosisneurogliocytehyperplasia inflammatorycellsinfiltration perivascularcuffing neuronophagia clinicalmanifestation incubationperiod 10 14days 4 21days typicalencephalitisbinitialperiodcrisisperiodconvalescentperiodsequelaperiod clinicalmanifestation initialperiod onthe1stto3rddaysabruptonsetfeverwithheadache nausea vomitinglethargy abdominalpain diarrhea clinicalmanifestation crisisperiod onthe4th 10thdayshighfever 40 sustainedfor7 10days alteredconsciousness lethargy confusion delirium stupor semicoma coma convulsionortwitch 40 60 respiratoryfailure 15 40 clinicalmanifestation centralrf reasonofcentralrf lesionofcerebralparenchyma respiratorycenterinjuryinoblongatamedulla cerebraledemabrainherniaintracranialhypertensionhyponatremicencephalopathy clinicalmanifestation manifestationofcentralrf cacorhythmicbreathing cheyne stokesbreathing apnea brainherniaperipheralrf dyspnea regularbreathing clinicalmanifestation othersymptoms signsofcnsmeningealirritations neckstiffnesskernigs brudzinskissignspositive deeptendonreflexesfromhyperactivetodisappearpathologicreflexespositivelimbsparalysis clinicalmanifestation convalescentperiodtdroptonormalin2 5daysneurologicfunctionregaingradually 2w remainsomebehavioral psychologicabnormalities aphasia dementia rigidityparalysis 6month sequela clinicalmanifestation sequelaperiodaphasiadementiapersistentparalysis clinicalmanifestation clinicaltype mildtypecommontypeseveretypefulminanttype clinicalmanifestation laboratoryfindings bloodpicture wbc10 20 109 lneutrophil 80 cerebrospinalfluid asepticmeningitistransparentorslightlycloudy pressuremaybeelevatedpleocytosis 50 500 106 lproteinmaybeelevatedmildlyglucoseandchloridearenormal laboratoryfindings serologicaltest specificigmab bloodorcsf 3 4dafteronset peakon2weekelisaorindirectimmunofluorescencecomplementfixingab 2weekafteronset peakon5 6week anamnesticdiagnosisepidemiologicinvestigation laboratoryfindings hemagglutinationinhibitionab 5dafteronset peakon2weekdiagnosis 4foldincreaseintiterepidemiologicinvestigationneutralizedabepidemiologicinvestigation laboratoryfindings pathogenictestvirusisolation blood csf braintissuert pcr rna diagnosis epidemiologicaldata 7 9month 10yrsclinicalmanifestation fever headache vomiting alteredconsciousness convulsion meningealirritation pathologicreflexespositive laboratoryfindings wbc csf igm differentialdiagnosis toxicbacillarydysenteryhighfever convulsion coma 24hcirculatoryfailure earlystoolexamination wbc rbccsf normalmeningealirritation negative differentialdiagnosis tuberculousmeningitiscsf meningealirritationpurulentmeningitisotherviralencephalitis treatment generaltherapy isolation preventingmosquitobiting t 30 nursing mouth skin eye turnoverclappingbacksputumaspiration treatment fluid electrolytesupplementationadult 1500 2000ml dchildren 50 80ml kg dsymptomatictherapyhighfever t 38 treatment physicalcooling icebag alcoholbathing coldsalineenema drugcoolingantipyreticsubhibernation chlorpromazine0 5 1mg kg timephenergan0 5 1mg kg time4 6h 3 5day treatment convulsion fever coolingbrainedema 20 mannitol1 2g kg time50 glucosedexamethason treatment sedative valium adult 10 20mg timechildren 0 1 0 3mg kg time10 chloralhydrate adult 1 2g timechildren 60 80mg kg timesubhibernation treatment respiratoryfailure keepairwayclearsputumaspirationturnover clappingback posturaldrainageaerosolizationinhalationofoxygen treatment reducingcerebraledema herniadehydrate 20 mannitol 1 2g kg time50 glucose vasodilator 654 2 adult 20mg timechildren 0 5 1mg kg time10 30min treatment respiratorystimulant lobeline adult 3 9mg timechildren 0 15 0 2mg kg timecoramine adult 0 375 0 75g timechildren 5 10mg kg timetrachealintubationortracheotomy biomotor treatment convalescent sequelaperiodacupuncturemassageexerciseetc prevention isolatingpatientsandpigimmunization killi