传染病总结一.doc

Communicable Disease传染病第一章总论 （总结人：赵瑞毓）1、 Infectious Disease:感染性疾病 it is a kind of human body infection, which is caused by pathogens ( virus、rickettsia立克次体、bacteria spirochete螺旋体、protozoa 原虫、worm) . include: communicable disease noncommunicable disease2、Communicable Disease: 传染病The infection of microorganism ( virus, rickettsia,立克次体 bacteria etc.) and parasite寄生虫 ( protozoa, worm) can result in a disease which can be communicated to others. And this kind of disease can at last cause pandemics 流行under certain conditions.3、Infection: 感染Parasitism寄生状态 of pathogens to humanbeings.4、Commensalism:共生状态 A relative balance state present between the microorganism (or parasite) and the host that can make them stay together peacefully without any mutual相互的 injury. 5、Opportunistic infection:机会性感染 The damage to the hosts immunity and the alter of the parasitic site both can result in the break of the commensalism balance, that cause injury of the host, this kind of infection called opportunistic infection. 6、Infection type：Primary infection 首发 Re-infection重复 Co-infection 混合 Super infection重叠7、Hospital acquired infection ( nosocomial infection)包括: cross infection交叉 endogenous infection内源性 iatrogenic infection 医源性8、 Infection Process：感染过程的表现Clearance/elimination of pathogen清除病原体Covert infection /subclinical infection隐形感染Overt infection /clinical infection 显性感染Carrier state 病原携带状态Latent infection 潜伏性感染9、Elimination of pathogen:清除病原体 不产生特异免疫 Defination:if the host has a non-specific or specific immunity,The invaded pathogen will be eliminated from the body, so the host has no any clinical manifestation.Cleared by: nonspecific immunity specific immunity active immunity passive immunity10、Covert infection /subclinical infection:隐形感染Defination: The reactions between the pathogen and the host are limited to a specific immune response, can not cause or can only cause very limited tissue injury without any clinical manifestations, this kind of infection can only be found by immunologic examinations . 主动免疫Covert infection /subclinical infection: outcome: 1.eliminating of pathogens 2.asymptomatic carrier 无症状携带者Significance : covert infection has a very important significance for preventing the spreading of infections diseases during epidemic period. 11、Overt infection /clinical infection:显性感染 Defination:when pathogens invade host, they will produce not only immune responds but also tissue injury、pathological injury and clinical manifestation through action of pathogens themselves and allergic reaction of host. 1.Result in: immune response tissue injury clinical manifestation 2.Outcome: restored to health recovery carrier12、Carrier state:病原携带状态 Defination:a host who coexist with pathogen present no evidence of disease but release pathogen.Common character: 1. Asymptomatic无症状携带者 2. discharging pathogen 排除病原体13、Carrier state:can be divided into 3 types on infection process:1. latent period carrier潜伏期 2. convalescent carrier恢复期3.chronic carrier慢性3 types on kinds of pathogen :1.virus carrier 2.bacteria carrier 3.worm carrier 2 types on time:1.acute carrier:3 months 2.chronic carrier:3 months14.Latent infection:潜伏性感染 Defination: when pathogen invade into host ,they will latent in the host for a long time. At that time ,they can not induce overt infection and also cannot be eliminated by host immunity ,Then they induce overt infection as soon as the host immunity weaked. Common character: 1.balance state between overt infection and clearance of pathogens.显性感染与清除病原体之间的平衡 2.asymptomatic 无症状携带者 3.no pathogen discharged无病原体排出(which is the different between it and carrier state.)15、Questions: difference between each type? The difference between type 1 (clearance of pathogen) and type 2 (covert infection/subclinical infection) ? The difference between carrier state and latent infection ?16、Basic conditions in epidemic process: 流行过程基本条件 1.Sources of infection 传染源 2.Routes of transmission 传播途径 3.Susceptibility of the crowd 人群易感染17、Routes of transmission: 传播途径Types: 1.respiratory tract transmission呼吸道传播 2.digestive tract transmission消化道传播 3.contact transmission 接触传播 4.entomophilous transmission 虫媒传播 5.blood, body fluid, blood product血液体液传播18、 zoonosis: 自然疫源性传染病Some natural environment make good conditions for transmission of a certain kind of communicable disease within wild animals, when humanbeings get into this environment, hell also be infected, this kind of communicable disease is called zoonosis.such as EHF18、 Communicable Disease Basic features 基本特征 Pathogen 病原体Infectivity 传染性 Epidemiologic feature流行病学特征 Post-infection immunity感染后免疫20、sporadic occurrence:散发 Defination:If the incidence of communicable disease is similar to former years level,it iscalled sporadic occurrence.21 epidemic:流行Defination:If the incidence of communicable disease is remarkablely higher than that of former years22、pandemic:大流行 Defination:when the popular range is too wide to overstep national boundaries or continent boundaries23、epidemic outbreak: 暴发Defination:the incidence of communicable disease occurs within a highly concentrated short time24、 Post-infection immunity:感染后免疫 specific active immunity25、Clinical features临床特点 Phases of the course: 阶段性 Incubation period 潜伏期 Prodromal period 前驱期 Period of apparent manifestation 症状明显期 Convalescent period 恢复期26 Incubation period:潜伏期 Defination:The period from invade of pathogens to appearance of the clinical manifestation.Character: asymptomatic 无症状携带者27 Prodromal period: 前驱期 Defination:the period from appearance of clinical manifestation to it become apparent. Character:nonspecific clinical manifestations such as: headache, fever, fatigue, inappetent etc.28 Period of apparent manifestation: 症状明显期Defination: it is the period of prominent of clinical manifestation. Character:specific symptoms and signs29 Convalescent period: 恢复期Defination:it is the period of termination of pathophysiological process and disappearance of symptoms and signs with the host immunity increasing to a certain level.30 Convalescent period:Character:increase of immunity to a certain level the process of pathophysiology nearly end up symptoms and signs nearly disappear relapse复发 and recrudescence再燃31 Recrudescence: In convalescent period, the temperature increase again before decrease to normal level which is called recrudescence.32 Relapse: In convalescent period, the temperature decrease to normal for a period of time, the pathogens incubated in the host multiply continually again to a certain degree, then the symptoms appear again called relapse.33 Diagnosis of communicable disease should be depended on information from: 1. Epidemiology 2. Clinical manifestations 3. Examination34 Administration of the source of infection: 管理传染源 class A: coerce administrated communicable disease (plague鼠疫, cholera霍乱)城镇2h,农村6h内上报 class B: strict administrated communicable disease (viral hepatitis, measles, epidemic hemorrhagic fever, epidemic cerebrospinal meningitis, typhoid fever)城镇6h,农村12h内。 class C: supervised administrated communicable disease( mumps, typhoid )发现后均在24h内上报第四章 细菌传染性疾病CHOLERA霍乱1 Cholera is an acute, sometimes fulminant 烈性infection of intestinal tract caused by vibrio cholerae.霍乱弧菌2 Clinically, the typical cases are characterized by a sudden onset of severe watery diarrhea腹泻 and vomiting呕吐, causing dehydration脱水 and muscle spasm肌肉痉挛 ,even circulatory failure and renal failure.3 An A-grade serious infectious disease be reported to local and state CDC within 26 hours. 4 V. cholerae is a short, slightly curved, rod shaped, gram-negative bacterium V. cholerae posses a rapidly motile by means of a single polar flagellum. It grows facultative anaerobic on nutrient media at 37, preferably at an alkaline pH.5 Ag of V. cholerae can be divided into O-Ag and H-AgClassification of V. cholerae( due to O-Ag) O1 serogroup of V. choleraeclassical biotype 古典生物型and El-Tor biotype埃尔托生物型 A B C Ogawa小川型,Inaba稻叶型,Hikojima彦岛型 Non-O1 serogroup of V. cholerae: O139 Atypical O1 serogroup of V. cholerae6 Source of infection : patients and carriers 7 Routes of transmission: gastrointestinal tract transmission water-contaminated water, foods, flies8 susceptible people : all people is susceptible most is covert隐形 infection . antibacterial Ab 抗菌and Antitoxin 抗肠毒素Ab9 Epidemiologic features: seasonal feature, regional feature 10 Diarrhea of cholera belongs to a kind of secretory diarrhea11 Pathophysiology: water and electrolyte disturbance: Dehydration脱水 and hypokalemia低钾metabolic acidosis: lose bicarbonate, anaerobic metabolism, acute renal failureCLINICAL MANIFESTATION12 Incubation period潜伏期 is nearly 1 to 3 days13 Classic biotype and O 139 serotype may produce a more severe expressions compaired with El-Tor biotype14 Typical manifestations of cholera can be divided into 3 stages stage of diarrhea and vomiting泻吐期 stage of dehydration脱水期 stage of reaction and convalescence恢复期或反应期1)Stage of diarrhea and vomiting 三无! sudden onset with severe diarrhea several times to more than 10 times per day with no abdominal pain or no tenesmus, yellowish and watery or clear with flecks of mucus stool ( rice-water stool), no fever in general.O139 fever and pain is general. vomiting :first diarrhea,then vomiting先泻后吐2)Stage of dehydration1 dehydration:Mild dehydration: (1000ml,child70-80ml/kg)Moderate dehydration:(3000-3500ml,child80-100ml/kg)loss of skin elasticity弹性, eyes sunken凹陷, hoarseness 嘶哑of voice, BP and urine volumeSevere dehydration :(4000ml,child100-120ml/kg) :no skin elasticity,cholera face霍乱面容, urine volume obvious, scaphoid abdomen 2.muscular cramps痉挛: cramps of gastrocnemius muscle and rectus abdominis, due to hyponatremia3. hypokalemia: the whole body weak, abdominal distention, tendon reflexes decrease, muscle weakness even cardiac arrhythmia4. metabolic acidosis: loss of sodium bicarbonate due to severe diarrhea which can cause the rate of respiratory increase ( Kussmaul respiratory), disturbance of consciousness 5.circulatory failure: hypovolemic shock .3)Stage of reaction and convalescence recovery from the disease if the diarrhea stop and dehydration corrected promptlymay develop pyretic reaction15 fulminant type( cholera sicca)干性霍乱: acute onset of toxic shock without expressions of diarrhea and vomiting LABORATORY TEST16 Stool examination: fecal routine: mucus and blood cells in small amount smear and dyeing: gram stain negative motility and inhibition test: quick diagnostic method bacterial culture: definitive identification Serologic examination: specific AbPCR method for examination of gene of V. Cholerae17 COMPLICATIONS:acute renal failure, pulmonary edema DIAGNOSIS考试重点18 19 20 !18 Determined diagnosis:according to one among the two follow 1. possess diarrhea and vomiting symptoms ,and the stool culture is positive with O1 or O139 2. In the search of infectious source , stool culture is positive at first and then diarrhea happen within five days.19 Clinical diagnosis: according to one among the two follow 1. possess cholera clinical manifestation of mild/moderate/severe/cholera sicca ,with definite etiologic examination in daily supplies or home environment. 2 In definite epidemic outbreak of cholera,exposure population possess cholera clinical manifestation of mild/moderate/severe/cholera sicca .20 Carrierthe stool or vomitus culture is positive with O1 or O139 ,without choleraic manifestation21 Replacement of water and electrolytes lost in stool and vomitus is the basis of cholera therapy.Isolation / fluid replacement / antibiotics /expectant treatment 治疗原则22 fluid replacement, oral fluids: ORS ,glucose 20g, sodium chloride 3.5g,sodium bicarbonate 2.5g, potassium chloride 1.5gfluid replacement , intravenous fluids:Rule:early, rapid, fullFirst salt, then glucoseFirst fast, then slowCorrect acidosis, supply calciumAdd potassium after have urine23 PREVENTION1)control source of infection isolation close contacts should be given medical surveillance for 5 days and given SMZ-TMP or norfloxacin for 2 days2)Interruption of the transmission routes3)Increase of individual immunityBacillary Dysentery细菌性痢疾1 DEFINITION: an acute bacterial infection of intestinecaused by Shigella called shigellosis志贺菌/痢疾杆菌gastro-intestinal transmission消化道传播summer and autumn outbreakpathology changes mainly locate in rectum and sigmoid flexure 直肠与乙状结肠mainly manifested by fever, abdominal pain , diarrhea, tenesmus, pus and bloody stools. In severe cases , infectious shock and /or toxic encephalopathy can be seen.2 ETIOLOGY 抗原结构Shigellae are gram-negative bacilli belonging to the family Enterobacteriaceae. 抵抗力resistancethe resistance of shigellae in natural environment is very strong (last 10-20 days), but it is very sensitive to common disinfections. 毒素toxin effect Each group of shigella can release endotoxin 内毒素which is responsible for the main toxic symptoms such as fever, toxemia and shock. (外白破霍内痢伤)3 EPIDEMIOLOGY Source of infection: patients & carriers. Route of transmission:fecal-oral route 粪口途径 through contaminated hands, foods, water etc.Susceptible group: All the people are susceptible Epidemic feature: area Summer & autumn Mainly happen in children and young person. 4 PATHOLOGYThe pathologic area of bacillary dysentery is colon, mostly related to rectum and sigmoid flexure直肠与乙状结肠 5 CLINICAL MANIFESTATIONS 1)the incubation period潜伏期 of dysentery is from 1 to 4 days.(hours to 7 days)6 Shigellosis can be devided into acute and chronic. Shigellosis lasts more than 2 months is chronic and usually caused by group B.（I）Acute dysenteryDivided into 4 type common type普通型-典型 mild type 轻型-非典型 severe type重型 toxic type 中毒性痢疾which also can be divided into shock, encepholopathy and admixture type1.Commom type l acute onset with high fever, accompanied with headache, fatigue, bad appetite and so onl abdominal pain and diarrheal Tenesmus里急后重l pus and bloody stools脓血便l tenderness of left lower part of abdomenl dehydration, imbalance of electrolyte and acidosis are seldom can be seenl The process of this type is nearly 1 to 2 weeks.2.Mild typel low fever l diarrhea no more than 10 times per dayl mucous stool without pus and bloodl slight tenesmus or even no tenesmusl last for nearly 3 to 6 days3.Severe type:l Acute feverl Diarrhea more than 30 times, pus and blood fecall Toxic intestinal paralysisl Peripheral circulation failure4.Toxic typel （1）shock type休克型( peripheral circulatory failure type): pale, coldness of limbs, weak pulses, piebald skin, cyanosis and decrease of BP.l （2）Encepholopathy type脑型( respiratory failure type): restlessness, convulsions, even coma, part of the patients may die due to central respiratory failure.l （3）Admixture type混合型: symptoms of both shock and encepholopathy type.（II）Chronic dysentery continuous type 慢性迁徙型 onset type 急性发作型 insidious type慢性隐匿型7 LABORATORY TESTS l blood routine: WBC (1020)109L, mainly increased by neutrophilic granulocyte. anemia can be seen in chronic patients.l Fecal routine: pus and bloody stool WBC15HP RBC also can be seenl aetiology examinations mainly depends on the culture of feces8 DIAGNOSIS:l Shigellosis should be considered in any patient with acute onset of fever and diarrhea:l Epidemiologyl Historyl Examination of the stool is essentiall Definitive diagnosis depends upon shigellae culture.l common type should be different from diarrhea due to other pathogens l Shock type should be different from other kind of septic shock l Encepholopathy type should be different from infection of CNS, especially epidemic encephalitis B 9 TREATMENT 1、 Acute dysentery 隔离至临床症状消失，两次粪便培养连续2次阴性。l general treatmentl pathologic treatmentl Fluoroquinolones such as norfloxacin & ciprofloxacin are the most effective drugs.l expectant treatment2、 Toxic dysenteryl pathologic treatmentl expectant treatmentl for high fever and convulsionl for shockl for encepholopathy三, Chronic dysenteryl general and expectant treatmentl aetiology treatmentl combination usage of antibiotics10 PREVENTION:Administrate the source of infection管理传染源Cut the transmission route 切断传播途径Protect the susceptable people 保护易感人群SCARLET FEVER猩红热1 DEFINITION:-hemolytic streptococcus group 链球菌Acute respiratory infectious disease急性呼吸道感染Clinical features: Fever ,pharyngitis, genernal diffused fresh red eruption 全身弥漫鲜红色皮疹and obvious desquamation 明显疹后脱屑Complication: heart,kidney and joints diseases2 Etiology:Belong to Group A, -hemolytic streptococcus Gram(+) 0.6-1.0um in diameterCulture培养:grow in media contained bloodGroup分组:depend on the different somatic polysaccharide Ag in cell wall,the bacteria are divided into 19 group(A-U,no I and J).Group A is major.Serum type血型:G