中南大学儿科教研室麻疹专题课件

1、麻疹 Measles第十章第一节（1）中南大学儿科学教研室9/13/20221麻疹目的要求熟悉麻疹的病因、流行病学及发病机制掌握麻疹早期诊断要点及典型临床经过熟悉其它类型麻疹的临床表现熟悉麻疹常见并发症掌握麻疹与其它发疹性传染病的鉴别要点掌握麻疹的防治原则及方法9/13/20222麻疹概述(overview)麻疹是一种由麻疹病毒引起的急性呼吸道传染病(Measles is an acute respiratory contagious disease caused by measles virus )9/13/20223麻疹概述(overview)临床特征为：发热、上呼吸道炎症、结合膜炎、Ko

2、plik斑及全身性斑丘疹(clinical features: fever,upper respiratory inflammation, conjunctivitis, Kopliks spots and generalized maculopapular rash) 9/13/20224麻疹病原(ETIOLOGY)麻疹病毒(measles virus)属副粘液病毒，无亚型，仅一种抗原型( RNA-containing virus of the Paramyxovirus family ,only one serotype) 9/13/20225麻疹病原(ETIOLOGY)麻疹病毒(meas

3、les virus)麻疹病毒不耐热，对日光和消毒剂均敏感，但在低温中能长期保存(Measles virus are rapidly inactivated by heat,light , and all kinds of desinfectant,but can be stored indefinitely at low temperature)。9/13/20226麻疹病原(ETIOLOGY)麻疹病毒(measles virus)存在于患者前驱期和出疹期的眼结膜、鼻、咽、气管等分泌物中(During the prodromal period and eruption period,it is

4、 found in sections of conjunctiva, nose , pharynx ,trachea and so on)。9/13/20227麻疹病理(PATHOGEY)多核巨细胞(multinucleated giant cells)：多个巨噬细胞融合形成的具有核内外包涵体的巨细胞网状内皮巨细胞也称华-佛细胞（reticuloendothelial giant cells or Warthin-Finkeldey cells)：存在于全身淋巴组织和肝、脾等脏器中上皮巨细胞（epithelial giant cells）：主要位于皮肤、眼结合膜、呼吸道和消化道粘膜等处 9/1

5、3/202210麻疹病理(PATHOGEY)皮肤、眼结合膜、鼻咽部、支气管、肠道粘膜等处可见单核细胞增生及围绕在毛细血管周围的多核巨细胞，淋巴样组织肥大(Prolifieration of mononuclear cells is found in the skin,in the conjunctivae and in the mucous membranes of the nasopharynx, bronchi, and intestinal tract,multinucleated giant cells occur around the capillaries. Hyperplasia

6、 of lymphoid tissue occurs.)9/13/202211麻疹病理(PATHOGEY)颊粘膜下层的微小分泌腺发炎，其病变内有浆液渗出及内皮细胞增殖形成Koplik斑 (An inflammatory reaction occurs in the fine secretor of the buccal mucosa, where serous exudate and proliferation of endothelial cells result in Kopliks spots) 9/13/202212麻疹典型麻疹前驱期 (Prodromal stage)指从发热至出疹,

7、一般为3-4天(from fever to rash appearance,usually lasts 3-4 days) 临床表现9/13/202216麻疹典型麻疹 主要表现：发热、上呼吸道炎症、眼结合膜炎、Stimson线(fever,upper respiratory inflammation, conjunctivitis ) 麻疹粘膜斑(Kopliks spots)前驱期 (Prodromal stage)临床表现9/13/202217麻疹Kopliks spots(麻疹粘膜斑) 时间：发疹前24 48小时出现(24-48 hours before the appearance of

8、 the rash)；位置：开始对着下臼齿的颊粘膜上；以后累及整个颊部并蔓延至唇部粘膜(initially opposite the lower molars but may spread the rest of the buccal and lip mucosa)。临床表现9/13/202218麻疹Kopliks spots(麻疹粘膜斑)形态：直径约1的灰白色小点，外有红晕(grayish white dots with 1mm in diameter,usually as small as grains of sand,that reddish areolae)；发展：1天内很快增多，皮疹

9、出现后逐渐消失(They spread rapidly within one day and disappear gradually after the appearance of the rash)。临床表现9/13/202219麻疹9/13/202223麻疹典型麻疹 恢复期(convalescent period) 皮疹按出疹先后顺序消退,伴有糠麸样脱屑及棕色色素沉着,经710天消失(The rash fades downward in the same sequence in which it appeared .As the rash fades , branny desquamati

10、on and brownish discoloration occur and then disappear within 7-10 days)临床表现9/13/202224麻疹 并发症(complications)肺炎(pneumonia) 是麻疹常见的并发症，多见于出疹期，继发细菌或其它病毒感染喉、气管、支气管炎(laryngitis,trachitis, bronchitis)心肌炎(myocarditis) 9/13/202225麻疹并发症(complications)麻疹脑炎及亚急性硬化性全脑炎（measles encephalitis and subacute sclerosing

11、 panencephalitis 简称SSPE)结核病恶化(tuberculosis exacerbating)营养障碍与维生素A缺乏症(malnutrition and vitamin A deficiency)9/13/202226麻疹诊 断(DIAGNOSIS)麻疹接触史(exposure to measles previously)典型临床表现(typical clinical manifestations)9/13/202227麻疹诊 断(DIAGNOSIS)前驱期鼻咽部找多核巨细胞及尿中检测包涵体细胞(During the prodromal stage, multinucleat

12、ed giant cells are found in nasopharynx,intrancuclear and intracytoplasmic inclusion bodies cells are found in urine)9/13/202228麻疹诊 断(DIAGNOSIS)ELISA法检测麻疹抗体(Measles virus antibodies become detectable by ELISA when the rash ppears;testing of acute and convalescent sera shows the diagnostic seroconver

13、sion or fourfold increase in titer)9/13/202229麻疹鉴别诊断病原全身症状和其他特征皮疹特点发热与皮疹的关系麻疹(rubeola)麻疹病毒卡他症状结膜炎、发热Koplik斑红色斑丘疹，特别的出疹顺序，退疹后有色素沉着几细小脱屑发热34天，出疹时体温更高风疹(rubella)风疹病毒耳后、颈后、枕后淋巴结肿大退疹后无色素沉着及脱屑发热半天或一天后出疹幼儿急疹exanthema subitum 人疱疹病毒6型一般情况好，耳后、颈后、枕后淋巴结可肿大颈及躯干部多见，一天出齐，次日消退高热35天，热退疹出猩红热(scarlet fever)乙型溶血性链球菌高热

14、，中毒症状重，咽峡炎、杨梅舌、环口苍白圈、扁桃体炎皮肤弥漫充血，密集针尖大小丘疹，1周后全身大片脱皮发热12天出疹，出疹时高热9/13/202230麻疹麻疹的流行病学及预防 流行病学(epidemiology) 传染源：急性期患者和亚临床型带病毒者 预防(prevention)控制传染源：隔离患者： 出疹后天，并发肺炎者10天。 接触过麻疹的易感者： 隔离检疫3周9/13/202231麻疹治 疗(TREATMENT) 无特异抗病毒治疗，只有支持治疗和对症治疗。(There is no specific antiviral therapy ;treatment is entirely suppo

15、rtive and symptomatic treatment)9/13/202234麻疹治 疗一般治疗 给予易消化的富有营养的食物，补充充足水分；保持皮肤、粘膜清洁9/13/202235麻疹治 疗一般治疗 卧床休息，房内保持适当的温度和湿度，有畏光症状时房内光线要柔和 (bed rest , keeping comfortably humidification and warm of the room ;patients with photophobia should be protected from exposure to strong light)。 9/13/202236麻疹治 疗对

16、症治疗 高热时可用小量退热剂。慎用退热药，烦躁者镇静。剧咳时镇咳祛痰。继发细菌感染可给抗生素，补充维生素A。9/13/202237麻疹麻疹的新进展 麻疹的发病年龄呈两极分化趋势婴儿麻疹增多，主要发生在8个月以前,多为非典型病例；大年龄患者增多。 麻疹的不典型病例增多。 发病高峰季节后移至3-5月份9/13/202238麻疹麻疹的并发症的变化： 心肌炎明显增多，且年龄越小，发病率越高。二次麻疹发生率: 在1%左右，其中60%发生在第一次麻疹二年以内。虽然麻疹病例增多，但病死率却很低。麻疹的新进展9/13/202239麻疹 麻疹前驱期最有诊断价值的表现 ( ) A 发热3-5天 B 有卡他症状 C Kopliks spots D 可见少数斑丘疹E 有麻疹接触史麻疹提问19/13/202240麻疹麻疹提问2麻疹最常见的并发症是： A 支气管肺炎 B