传染病学 07 恙虫病ppt课件

ScrubTyphus 恙虫病 DepartmentofInfectiousDiseases theThirdAffiliatedHospitalLiGang 李刚 Definition Acutefebrile 发热性的 infectiousDiseaseCausedbyRickettsiatsutsugamushi 恙虫病立克次体 Transmittedbythebiteofchiggers 恙螨 Definition Sourceofinfection RatsCharacterizedbyfever eschar 焦痂 rash andlymphadenopathy Etiology IntracellularorganismPropagatedinmice somecellsAntigenicallydiverse 多样的 microorganismCommonantigenwithProteus 变形杆菌 OX KLowresistance Epidemiology Sourceofinfection RatsVector Mite 螨 Thelifecycle ovum larva pupa naiadandimagoOnlyitslarva chigger feedingonhumans Epidemiology Otherepidemiologicalfeatures Geographicdistribution Asian pacificregionSporadicSeasonaldistribution rainyseasonsbetweenMayandNovember Pathogenesis Basiclesion inflammationofthewallsofthesmallbloodvesselsPathologicfindings eschar lymphadenopathy rash enlargementofspleenandliverSeriouspathologicmanifestations myocarditis meningoencephalitis pneumonia interstitialnephritis Pathology Clinicalmanifestations Incubationperiod 4 21daysSuddenonset Highfever remittentfever 弛张热 accompaniedbychill headache malaise 不适 prostration 疲惫 poorappetite Clinicalmanifestations Signsofmultiorgandamage Meningoencephalitis delirium 谵妄 convulsion 抽搐 coma andneckstiffnessInterstitial 间质性 pneumonia cough chestpain breathlessness Clinicalmanifestations Signsofmultiorgandamage Myocarditis gallop 奔马 rhythm poorqualityheartsounds systolicmurmursHepatitis jaundice hemorrhageNaturalcourse 2 3weeks Characteristicmanifestations 1 EscharandulcerationCharacteristicsignSeenin36 9 98 ofpatientsGenerallylocatedinwarm wet intensesmelledareas eschar eschar ulceration Characteristicmanifestations 2 LymphadenopathyEnlargedmarkedlyregionallymphnodesneartheescharGeneralizedlymphadenopathyPainful movable notpurulent 脓性的 Characteristicmanifestations 3 RashAppearsonthe4thtothe6thdayBeginningonthetrunk spreadtotheextremitiesMaculopapular 斑丘疹 congestive noitching 痒 Lasting3 7daysSeenin35 100 ofpatients Characteristicmanifestations 4 SplenomegalyandhepatomegalySplenomegaly 30 50 ofpatientsHepatomegaly 10 20 ofpatients Complications Pneumonia myocarditis hepatitis DIC Diagnosis 1 EpidemiologicdataHistoryofexposuretoendemicareasRainyseason Diagnosis 2 ClinicalfeaturesAbruptonsetoffeverAccompaniedwithchill lymphadenopathy rash enlargementofspleenandliverMostcharacteristicsign escharTherapeuticdiagnosis Diagnosis 3 LabfindingsA RoutinelabdataWBC liverenzymevalues proteinuriaB Serologicaltests Weil Felixreaction Diagnosis Weil Felixreaction Positiveresultobtainedfromthe4thdayHigherthan1 160issuggestiveAvailableandinexpensiveAbout50 ofpatientshavediagnostictiters 滴度 Diagnosis Complement 补体 fixationtestandindirectimmunofluorescent 免疫荧光 antibodytest MoresensitiveandspecificthanWeil FelixreactionFourfoldorgreaterincreaseinconvalescenceRarelyusedbecauseofthedifficultinpreparingantigens Diagnosis C IsolationoforganismBloodinoculatingintomiceOrganismfoundinmononuclearcellsSpecifictesttoconfirmthediagnosisCan tgivearapiddiagnosis Diagnosis D MolecularbiologicassaysNucleicacidhybridizationandPCRGreatpotentialforsensitiveandspecificdetectionofnucleicacidBeingevaluatedLimitationoftechniqueandfacilitiesconditions DifferentialDiagnosis Otherrickettsialdiseases typhoidfever leptospirosis malaria dengue septicemia influenza Prognosis Fatalityrate 9 60 withouttreatment 5 effectivetreatment Treatment Chloramphenicol tetracycline doxycyclineChloramphenicol 1 5 2gdaily dividedinto3 4aliquotsFeverabateswithin48hoursTotalcourse 10 14daysSideeffects suppre