发病数居前五位的病种为肺结核乙型肝炎梅毒丙肝 课件

发病数居前五位的病种为 肺结核 乙型肝炎 梅毒 丙肝 痢疾 占发病总数的90 06 死亡数居前五位的病种为 艾滋病 肺结核 狂犬病 乙型肝炎 丙肝 占死亡总数的91 05 卫生部2009年3月10日 2009年2月全国法定传染病疫情报告 2009年2月1日零时至2月28日24时 发病数居前五位的病种为 肺结核 乙型肝炎 麻疹 梅毒 痢疾 占发病总数的88 40 死亡数居前五位的病种为 艾滋病 肺结核 狂犬病 乙型肝炎 流脑 占死亡总数的88 82 卫生部2008年3月10日 2008年2月全国法定传染病疫情报告 2008年2月1日零时至2月28日24时 发病数居前五位的病种为 肺结核 乙型肝炎 梅毒 痢疾 麻疹 占报告发病总数的86 89 死亡数居前五位的病种为 狂犬病 肺结核 乙型肝炎 艾滋病 流脑 占报告死亡总数的89 58 卫生部2007年3月12日 2007年2月全国法定传染病疫情报告 2007年2月1日零时至2月28日24时 2007年与2006年相比 与2006年相比 2007年甲乙类传染病中 呼吸道传染病和血源及性传播传染病报告发病率分别上升3 55 和6 96 呼吸道传染病中的猩红热和麻疹上升幅度较大 病例数分别上升了20 61 和8 88 血源及性传播传染病中的艾滋病 丙肝和梅毒上升幅度较大 病例数分别上升了45 04 30 01 和24 09 自然疫源及虫媒传染病和肠道传染病报告发病数分别较2006年下降19 20 和9 19 PrimaryPulmonaryTuberculosis Threelandmark humancontrolTBMar 1882RobertKoch Germany Effectivechemotherapeutics 1944SM 1950INH ProtocolsinMolecularBiologyusedinTBresearch Significantprogressinchemotherapy Greatlyimproveefficacy Overview TuberculoticcurrentsituationAIDSandTBco infectionabout40 50 AIDSandTB ShowedadverseeffectsoneachotherHIVleadtoPotentialTBexposeanddeteriorateTBbecomeanearlycomplicationafterinfectedwithHIVTBleadtoAIDSprogressionanddeathMostdiedofPneumocystiscariniidisease bacterialpneumoniaafewdiedofTB Overview TuberculoticimmunizationCellularimmunityIncidenceofinfectiondependson Amount flora toxicumofbacterialImmunefunctionofbodyAffectability geneticfactor PatientwithAntigenHLA Bw35 incidenceofTB relativerisk7 38 TBM relativerisk15 21 Overview ClassificationofTB primarypulmonarytuberculosis l型 Hematogenousdisseminatedpulmonarytuberculosis ll型 SecondarypulmonaryTuberculosis lll型 Tuboerculuspleurisy tuberculouspleuritis lV型 Extrapulmonarytuberculosis V型 PrimaryPulmonaryTuberculosis oneofthemostcommonclinicaltypeinchildrenprimaryinfectionPrimaryPulmonaryTuberculosis PrimaryComplex TuberculosisofBronchialLymphnodes Primarycomplex原发综合征 primarylesions lymphangitis Lymphadenitis TuberculosisofBronchialLymphnodes支气管淋巴结结核 胸内淋巴结结核 Thescopeofprimarylesionsaresmallorhasbeenabsorbed Pathology Location Right SidedMostly Subpleuralbottomoflobussuperiorpulmonisupsideoflobusinferiorpulmonisbasiclesion Exudativelesions 渗出 Proliferativelesions 增殖 Caseousnecrosis 坏死 ChiefPathologycharacteristic EpithelioidcellsnodulesLangerhanscellularinfiltrationAhighdegreeofallergystatusinchild ExtensiveinflammatoryaroundlesionsTheyounger themoreobviouslargelesions result Pathologicalprognosis1 AbsorptionCompleteabsorption CalcificationorScleromaCalcifiedlesionsoccuratleast6to12months2 progressionExpandlesionsBronchiallymphfistulaAtelectasis EmphysemaTuberculouspleurisy3 DeteriorationHematogenousdissemination clinicalmanifestation symptom 1 fever2 PoisoningsymptomsofTBanorexia acratia Sweating 盗汗 3 respiratorysymptomLittle MayhaveadrycoughPerformanceinaseriouscondition cough Alargenumberofsputum hemoptysis dyspnea 4 Oppressionsymptom OppressRecurrentLaryngealNerve HoarsenessOppresstrachea bronchus Cough Wheeze 喘鸣 ExpiratoryorInspiratoryobstructionOppressveins PuffinessoffaceOppressphrenicnerve Nausea vomiting hiccup clinicalmanifestation clinicalmanifestation signsPulmonarysigns lessExtra pulmonarySigns Herpesconjunctivitis SkinerythemanodosumorMultipleone offarthritis diagnose Significanceofearlydiagnosis History Askedindetailabout HistoryofexposureandBCGvaccination HistoryofinfectiousdiseasesNoticenutritionalstate immunefunction clinicalmanifestation PPD TestPPD ProteinPurifiedDerivative 纯蛋白衍化物Method intradermalinjections0 1ml 皮内注射 含5个结核菌素单位 diagnose PPD Test PPD Test positiveclinicalsignificance AfterBCGvaccinationHavebeeninfectedwithTBSufferingfromtuberculosis thereisanewdiseaseactivityClinicalcure TBisnotdeadFromnegativetopositiveorthelevelofthereaction20mm Andanincrease 6mm showthatthereisnewlyinfected 广泛推行BCG接种后 PPD试验的诊断价值受到一定限制 PPD Test PPD Test negativeclinicalsignificance NotinfectedwithTBInpre allergicstage aftertheinitialinfection4 8weeksImmunesystemhypofunctionortemporaryinterference Falsenegative PPDexpiredortechnicalmisconduct X rayexamination1 Primarycomplex Primarylesion Cord likelymphaticvesselsSwollenlymphnodes diagnose 原发综合症女 3岁 初染病灶在右上叶基部 支气管淋巴结肿大 X rayexamination 2 TuberculosisofBronchialLymphnodes Cancertype nodulartype 左侧支气管淋巴结结核 肿瘤型女 6岁 母有开放性肺TB 病史2年 X rayexamination 2 TuberculosisofBronchialLymphnodes Infiltratingtype Inflammationtype 右侧支气管淋巴结结核 浸润型女 5岁 脑脊液呈典型TBM改变 支气管淋巴结结核伴发淋巴结周围炎 otherauxiliaryexamination1 Findingtuberclebacillusinsputumorgastricjuice2 Superficiallymphnodebiopsy3 Peripheralblood4 ESR5 Flexiblebronchofiberscopeexamination6 AntibodyofTB diagnose DifferentialDiagnosis 1 beforeChestX rayinspectionURI tracheitis rheumaticfever2 AfterChestX rayinspectionpneumonia bronchiectasis treatment principle early combine appropriateamount regularity wholerangeUntreatedTB atleast10persons per100personsresistantforaanti TBdrug thereisatleast1person per100personsresistantforMDR TB multi drugresistant Re treatedTB previousacceptedanti TBtreatmentmorethanonemonth atleast20persons per100personsofadrugresistance 7persons per100personsMDR TB course Short termtherapygeneraltreatment Rest Nutrition regularlife Drugtherapy 6HR或9HR Serious addonS2月 2SHR 4 6HR orZ3月 3HRZ 3 6HR DrugClassification USA Maximumeffect Minimaltoxicityeg INH RFP Greatereffect Greatertoxicityeg SM EMB PZA Minimaleffect Maximumtoxicityeg KM treatment thebasicmechanismofShorttreatment FastkilltuberclebacillusinthebodayDifferentpropagationspeedinsideandoutsideoftheCellsThebasiccharacteristicsofshort termtherapy 1 sputumcultureturnnegtivequickly2 lowincidenceofthelong termrecurrence3 fullcourseoftreatmentfailureless thehighrateo