人卫版8年制病理学 18传染病及真菌病课件

Pseudomembaneisfibrinsuppurativeexudateinnature Justonthesurfaceofthemucosaofaffectedcolonfirstlythepseudomembranepatchilydistributedandthendiffuselycoverthemucosaandproduceadirtymembranousmatter Undermicroscope thepseudomembraneiscomposedoffibrins numerousneutrophilsadmixedwithredcells celldebtisandbacteria Whentheseudomembranesheds theirregularsuperficialulcerappears maplikeulcers Follow pseudomembranousinflammation Later theulcershealandthepatientsrecover Bacillarydysentery Bacillarydysentery Acutebacillarydysentery ClinicappearanceToxaemia fever peripheralbloodleukocutosis Inflammatory abdominalcramping irritationdiarrheawithmucus bloodandpusinthestool tenesmus Complication hemorrhage perforation lesscommonly dehydration electrolyticdisturbance inseriouscases Fate healing mostcases insomecases protractedandpassintoachroniccondition Chronicbacillarydysentery Courseofdiseasehasbeenexceededmorethan2months Suchchroniccasesarecharacterizedbyrepeatedinjuryandrepair ulcerationandhealing andcanleadtonewandoldlesionscoexist chroniculcerformation polypoidmucosalirregularitywithfibrousscarringandsubsequentstenosisofthebowel Clinicappearance Abdominalpain chronicdiarrheaintestinalobstruction ToxicbacillarydysenteryThemostcommoninchildren Oftenfromorganismoflowervirulence theonsetofdiseaseissudden Intestinallesionischild showingcatarrhenteritisorfollicularenteritis Thereareseveregeneraltoxicsymptoms highfever convulsion Afteronsetsomehours toxicshockandcomaorbrainedemaandrespiratoryfailureappearrapidly Gonorrhea Gonorrheaissupprurativeinflammationcausedbygonococciandisoneofthemostcommonsexuallytransmitteddisease whichhasahighprevalenceandverystronginfectiousness 1 EtiologyandpathogenesisPathogen Neisseriagonorrhoeae gonococci gram negativeDiplococcusTheorganismisafacultativeintracellularpathogenthatbindstoandinvadesepithelialcellsthroughthepiliintheenvelopeofgonococcusandsecretedIgAproteo lysticenzyme Thepolysaccharidesofcapsularcontributetovirulencethroughinhibitingphagocytosisintheabsenceconditionofantigonococcalantibody Inaddition thepathogenreleasespeptidoglycansandendotoxin whichinducehostcellsecretionofTNF thatmaycausedamagesofinfectiousepitheliacells Sourceofinfection patientsandasymptomaticcarriers Routesofinfection usuallythesexualcontactsintheadults bytheindirectcontactinthechildren inaddition gonococcalinfectionmaybetransmittedtothefetusdutingdeliverythroughthebirthcanal producingneonatalophthalmitis 2 PathologyMainlyaffectedurinarygenitalsystem Lesionsshowpurulentinflammationfollowedbygranulationtissueformationandfibrosis Inthemale theorganisminfectschieflytheurethra producingacuteurethritis Theprostate seminalvesiclesandepididymidesarecommonlyinvolved Inthefemale thecervixisthemainsiteofinfection theurethra Bartholin sandSkene sglandsandtheuterinetubesarecommonlyinvolved About1 3 ofcases theorganismsenterintothebloodstreammaycausegonococcalendocarditis arthritis dermatitissyndrome meningitis Infatalcases diffuseintravascularcoagulation DIC withtheWaterhouse Friderichsensyndromemayoccur 3 ClinicalfeatureSystemicsymptomsareusuallyabsent Inmen thecommonpresentationiswithdysuriaandpurulenturethraldischarge Inwomen cervicitismayproduceavaginaldischarge 4 ComplicationsSterilitymanresult Inthemale prostateabscess urethralstricture hydropsofkidney Inthefemale anincreasedrickofectopicpregnan cyentryofgonococciintothepelvicperitoneumviatheuterinetubesmaycauseperitonitis Condylomaacuminatum Itisasexuallytransmitted papillotumor likelesion causedbyhumanpapillomavirus HPV HPV 6 11type thevirusmultiplyintheepithelium specificallyinthematuresquamouscells causingcytologicchange koilocytosis Routesofinfection resemblingthoseofGonorrhea Locationofthelesion onanymoist mucosa cutaneousuctionalregionoftheexternalgenesis PathologyGross singleormultiplesessileorpedunculatedredverruciformexcrescences Lesionsfromafewmillimeterstoseveralcentimetersindiameter Microscopically HyperplasticepitheliumshowpapillaryhyperkeratosisorparakeratosisKoilocytosis characteristiclesion Congestionandlargenumberinflammatorycellsinfiltrationbeneaththeepidermis Fate dysplasiacanceration Condylomaacuminatum ThetoprightshowsHPV 6 11inIHC TheLowerleftshowsKoilocytosis Syphilis Syphilisisanimportanttransmitteddiseaseandalsoachronicinfectiousdisease latesyphilisoccurs4ormoreyearsfromthedateofinfection Atearlystage itmaybeasymptomaticandatlatestage itmayinvolvemanyvitalorgans suchasliver brainandaorta withmultipleclinicalfeatures Latentsyphilis aspecifictreponemalantibodytestispositivenoclinicalfeaturesofsyphilisandnormalcerebrospinalfluid Over70 ofpatientsneverdeveloplatestageofsyphilis aminority However thepatientscanintermittentlyseedthebloodwithtreponemesandbecapableofcausingtransfusionandtransplacentalinfection 1 Etiologyandpathogenesis Pathogen treponemapallidum aspirochetepallida Tpallidumisadelicateorganism rapidlykilledbydryingortemperaturechange Mucousmembranesaretheoptimalsitesofinfection Onlydirectlysexualcontact Tpallidumcanpenetrateintactmucousmembranesandabradedskincausinginfection Theorganismhasastronginvasiveness Treponemapallidum dark fieldmicroscopy showingseveralspirochetesinscrapingsfromthebaseofachancre Sourceofinfection patientsandlatentsyphilis Routesofinfection 95 ofinfectionthroughintimatesexualcontact rarelyinfectionthroughdirectcontact transfusion kiss etc adultssyphilisverticalinfectionthroughplacentafromthemotherwithsyphilis congenitalsyphilis Pathogenesis Afterinfection invasivenessofspirochaetepallidaandhostimmunologicresponsedeterminedevelopmentandprognosisofthelesions Intheearlystage hosthumoralimmuneresponsesmayproducetheantibodiesagainstTpallidumspecificantigens plasmacells infiltration lesionhealsspontaneously Inthelatestage cellularmediateddelayedtypehypersensitivity granuloma Proteanmanifestationsofsyphilis 2 EssentialpathologicalchangeObliterativeendoarteritisandperiarteritisGumma syphiloma Alocalizeddestructivegranuloma morecommonintheliver bonesandtestes Gross grey white firmandrubbery irregularlesionfromafewmillimeterstoseveralcentimeterindiameter Microscopically centralareaofgummatousnecrosis surroundedbyepithelioidcells lymphocytes numerousplasmacellsandfibrosis Trichromestainoflivershowsagumma scar stainedblue causedbytertiarysyphilis Showingagumma scar causedbytertiarysyphilisinliver 3 Acquiredsyphilis adultssyphilis Primarysyphilis Theincubationperiodafterinfectionis9 90days duringthistime treponemesmultiplylocallyandspreadtolymphnodesandblood Thefirstvisiblelesionistermedthechancre Thechancreappearsatthesiteofinitialinvasionusuallythepenisinthemaleandthevulvainthefemale Gross apainless punched outulcerwithaninduratedbase hardchancre Itssurfaceexudesaserousfluidcontaininglargenumbersoftreponemes Microscopically thebaseofchancreconsistsofchronicinflammatoryresponsewithnumerousplasmacellsandthevascularlesionsofsyphilis Afterto2weeksfollowingthechancrepainlessenlargementoftheinguinallymphnodesmaybepresent Thechancrehealsspontaneouslyin3 6weeks Syphiliticchancreinthescrotum SecondarysyphilisUsuallyfollowstheprimarystageafter2 20weeksItischaracterizedbyfever generalizedlymphnodesenlargement aredmaculopapularskinrash syphilis andcondylomaflat plaque likelesionintheperineum Microscopically characterizedvascularlesionsofsyphilisandnonspecificchronicinflammatoryresponsespirochetesarepresentinlargenumbersSpontaneouslyresolvewithorwithouttherapy TertiarysyphilisAppearanytimeafter4yearsfollowingprimaryinfection Tertiarylesionsmayoccurinanytissue especiallyinthecardiovascular 80 85 centralnervoussystem 5 10 liverandbonescausingextensivedestructionandleadingtoseriousdamagesoftheaffectedvisceralorgans Neurosyphilis 1 ChronicmeningovascularsyphilisCausesabasalchronicinflammationwithmarkedfibrosisandobliterativevasculitis withlargenumbersofplasmacellsinfiltratingthemeninges granulomasarenotpresent 2 Parenchymatoussyphilis Affectthecerebralcortexcausinggeneralparesis Affectthespinalcordcausingtabesdorsal Cardiovasculasyphilis Involvementoftheaortaiscommon AneurysmsAorticvalveincompetence Myocardialischemiasecondarytocoronaryostialnarrowingduetoaorticfibrosis 4 CongenitalsyphilisIntrauterineinfectioncaused