传染病学英文版课件：Infectious diarrhea

Bacillarydysentery

细菌性痢疾Shigellosis志贺菌病Infectiousdiarrhea传染性痢疾2023/4/12Shigellosis2Contents目录Generalcondition概述Etiology病因Epidemiology流行病学Pathogenesis发病机理Clinicalmanifestation临床表现Laboratoryexamination实验室检查Diagnosis诊断Treatment治疗Prevention预防2023/4/12Shigellosis31.Generalcondition概述Definition:定义

Shigellosisisalsocalledbacillarydysentery,thisisanacutebacterialdiseasecharacterizedbyfever,nausea,vomiting,cramps,diarrheaandfeelingoftenesmus

causedbyShigellaspecies.Inmostcases,thestoolscontainbloodandmucus.志贺氏菌病也称为菌痢,这是一种由志贺氏杆菌引起的急性细菌性疾病,其特征是发热、恶心、呕吐、抽搐、腹泻及里急后重感

。在大多数情况下,粪便中包含血液和粘液。

2023/4/12Shigellosis42.Etiology病因Shigella:志贺氏杆菌：Gram-,facultativeanaerobic(withorwithoutoxygen),rodbacteria革兰阴性，兼性厌氧（有氧或无氧），杆菌VerysimilartoE.coli非常类似于大肠杆菌pH:survivesinneutralpH,resistanttostomachacidspH:存活于中性pH，耐胃酸Temperature:(dependsonserotype..)温度：（取决于血清型）Cansurviveat4°Cfor21daysincheese,potato,saladandmayonnaise可以在4℃下在奶酪，马铃薯，沙拉和蛋黄酱中存活21天Cansurviveandgrowatunder25°Cfor50daysinflour,milk,eggs,shrimps,oyster

可以在25℃，在面粉，牛奶，鸡蛋，虾，牡蛎中存活50天2023/4/12Shigellosis52023/4/12Shigellosis6Shigellabacteriainastoolsample(Underhighpowermicroscope)粪便样品中的志贺氏菌（在高倍显微镜）2023/4/12Shigellosis7Gramstain:Shigella革兰染色：志贺氏菌2023/4/12Shigellosis8SeveralmediahavebeendesignedtoselectivelygrowentericbacteriaandallowdifferentiationofSalmonellaandShigellafromE.coli.Theprimaryplatingmediashownhereareeosinmethyleneblue(EMB)agar,MacConkeyagar,ENDOagar,Hektoenenteric(HE)agarandSalmonella-Shigella(SS)agar.几个培养基制成可以选择性地生长肠细菌，从大肠杆菌中分化沙门氏菌和志贺氏菌。这里显示的平板为伊红美蓝（EMB）培养基，麦康凯培养基，远藤培养基，HE培养基和SS选择鉴别培养基。2023/4/12Shigellosis93.Epidemiology流行病学Worldwide,majorcauseofdiarrhea在世界范围内，主要原因是腹泻165millioncases/year(99%indevelopingc.)165000000例/年（99%在发展中C）Isabout5-15%ofallcasesofdiarrhea,mostlykids<4yrs在所有例腹泻中，约5-15%大多数是小于4岁儿童600,000to1.1milliondeaths/year每年有600000到1100000人死亡China:32.36cases/100,000people中国：在100000人中有32.36例Nepal:??India:??(Thereisnoaccuratedata)尼泊尔：？？印度：？？（没有准确的数据）2023/4/12Shigellosis10Epidemiology流行病学Sourceofinfection传染源Acuteorchronicpatientsandcarriers

急性或慢性患者和携带者Routeoftransmission传播途径Foodorwatercontaminatedbyfeces被粪便污染的食物或水Susceptibility敏感性Mostpeople,especiallyinchildren大部分的人，特别是儿童Canacquiretemporaryimmunityafterinfection在感染后可以获得短暂的免疫性2023/4/12Shigellosis114.Pathogenesis发病机理Smallintestine:小肠：LittlereproductionProduces“Shiga-toxin”产生“志贺毒素Likecholerawaterstools如霍乱水样便Largeintestine:大肠：Colonization:attaches,invadesandmultipliesincells

inflammatoryresponseandcelldeath

Bloodymucusstools定植：粘附、侵入、在细胞中繁殖炎症反应和细胞死亡脓血便2023/4/12Shigellosis122023/4/12Shigellosis13animation:ShigellaPassingThroughtheMucousMembrane

andInvadingMucosalEpithelialCells动画：志贺菌通过侵入粘膜和粘膜上皮细胞2023/4/12Shigellosis14Pathogenesisoftoxicdysentery

中毒性痢疾的发病机理Overall,themechanismisnotclear.总的来说，其机制尚不清楚。Itmayberelativetosuper-allergyreactioncausedbyendotoxin,particularlyinchildrenwithspecialimmunity.它也许与内毒素引起的超敏反应有关，特别是特殊免疫儿童。Toxicencephalopathyisresponsiblefordeathofchildren中毒性脑病导致儿童死亡2023/4/12Shigellosis155.Clinicalmanifestation

5.临床表现Incubationperiod:1to2days(upto7days)潜伏期：1到2（最多7天）Duration(courseofdisease):4daysto2weeks持续时间（病程）：4天到两周2023/4/12Shigellosis16Clinicaltype临床类型Typicaltype普通型Mildtype轻型Toxictype中毒型2.ChronicShigellosis慢性菌痢1.AcuteShigellosis急性菌痢

2023/4/12Shigellosis17Clinicaltype临床类型Typicaltype普通型Symptoms:症状：Suddenlyonset起病急Wholebodytoxemia:chill,fever,fatigue,,headache…全身毒血症：寒战，发热，乏力,头痛......Crampingabdominalpain,especiallyinleftinferiorabdomen腹部绞痛，尤其是在左下腹部Diarrhea:waterstoolinitially,thenbloodypurulentstools,10~20timesperday.腹泻：开始为稀便，然后脓血便，每日10〜20次。BurningsensationatAnus---tenesmus,duetonervesofrectumbeingstimulatedbylocalinflammation,asymptomcharacterizedbyincompletesenseofevacuationwithrectal(anus)pain在肛门灼热感---里急后重，由于直肠神经受局部炎症，其特点是疏散不完全感直肠（肛门）的症状疼痛被刺激Signs:体征：Press-painontheleftinferiorabdomen

(appendicitis:ontheright!)左下腹部压痛（阑尾：在右边）2023/4/12Shigellosis18ClinicaltypeMildtype轻型Mildtoxemia,nosignificantfeversometimes轻度毒血症，不发热或低热Withouttypicalbloodypurulentstools,thefrequencyofthestoolsislessthan10timesperday.无典型脓血便，每日大便不足10次Mostcasescanrecovercompletelyandtherestmaybedevelopedintochronic.

大多数情况下，可以完全恢复，其余的可发

展成慢性。2023/4/12Shigellosis19ClinicaltypeToxictype中毒型Usuallyfoundinhealthychildrenwith2~7yearsold.Onsetsuddenlywithfever(400C)andserioustoxemiaToxinencephalopathyMentaldisorder:lethargy,coma.Toxinencephalopathyrespiratoryfailure.Infectiousshock:BPdecrease,skinbecomecold,multiorganfailureinvolvesthekidney,lungs,andliver;DIC(disseminatedintravascularcoagulation)andheartfailuremayalsooccur.Withoutdiarrheaorabdomenpainusually2023/4/12Shigellosis20Clinicaltype临床类型Chronictype慢性菌痢Havingapasthistoryofacutebacillarydysentery有急性菌痢病史Havingrecurrentorpersistentabdominalpain,accompaniedbydiarrheaoralternationofdiarrheaandconstipation.反复发作性或持续性腹痛，伴有腹泻或腹泻与便秘交替。Intermittentappearanceofmucopurulentandblood-stainedstools.常有粘液脓性血斑斑大便。2023/4/12Shigellosis216.Laboratoryexamination

6.实验室检查Generallyspeaking：一般来说：Virusinfectiousdiseases:WBCisnormal

病毒感染性疾病：白细胞是正常的Bacterialinfectiousdiseases:WBCisveryhigher.细菌感染性疾病：白细胞非常高。EpidemicencephalitistypeB:WBCishigher.Infectiousmononucleosis:WBCishigher.流行性乙型脑炎：白细胞较高。传染性单核细胞增多：白细胞较高。Tuberculosis:WBCisnormalTyphoidfever:WBCislower结核病：白细胞是正常的。伤寒：白细胞较低Specialcircumstances:特殊情况：virus病毒Bacterial细菌2023/4/12Shigellosis22Laboratoryexamination实验室检查Bloodtest:WBC>10~20×109/L血液检查：白细胞>10〜20×109/LStooltest:Bloodypurulentappearance.Leukocytescanbefound>15/HP粪便检查：血脓性外观。白细胞可以发现>15/HPBacteriaculture:(+),thedysenterybacillusofthecultureisagoldenstandardofdiseasediagnosis.细菌培养：（+），培养的痢疾杆菌是疾病诊断的标准Early,frequently,freshlycollectsample

(inoculatedculture

)-----canimproveculturepositiverate.早期，频繁，新鲜采集的样品（接种培养）-----可提高培养阳性率。Bloodculture:unnecessary!血培养：没有必要！2023/4/12Shigellosis237.Diagnosis诊断Epidemicdata(exposedtopatients)流行病学资料（接触病人）Clinicalfeature(typicaltype)临床特征（典型类型）Laboratoryfindings实验室检查结果Aimingtotoxicdysentery,checkingstoolsbydigitalrectalexamination(DRE)orcoldsaltliquidenemaisthemostimportantdiagnosismethod.旨在中毒性痢疾，通过直肠指诊（DRE）或冷盐水灌肠液检查凳子是最重要的诊断方法。2023/4/12Shigellosis248.Treatment治疗Acutedysentery急性菌痢Antibioticsmedicationisveryimportant.抗生素药物是非常重要的。Toseverecases,treatmentwithantibioticscanshortenthe

duration

oftheillness.andcanreducetheperiodof

excretion

oftheorganism.严重的情况下，用抗生素治疗即可缩短疾病的持续时间。并能降低生物体的排泄时期Tomildcases,treatmentwithantibioticsisunnecessary.轻度情况下，用抗生素治疗是不必要的。2023/4/12Shigellosis25Selectionofantibiotics选择抗生素Thefirstlinemedicationshouldbequinolones,suchasnorfloxacin(0.4tidforadult)orCiprofloxacin(0.2tidforadult)orOfloxacin(0.2tidforadult).Thedurationis3~5daysfortypicalcases.第一次用药应选用喹诺酮类药物，如诺氟沙星（0.4TID成人）或环丙沙星（0.2TID成人）或氧氟沙星（0.2TID成人）。该典型病例持续时间为3〜5天。Forseverecases,Quinoloneor3rdcephalosporin,suchasCeftriaxoneorcefotaximewerechosenwithveinroute.对于严重的情况下，静脉注射喹诺酮类或第三头孢菌素，如头孢曲松或头孢噻肟Becauseofhighdrug-resistanceandunsafety,sulphonamidesorchloramphenicolwerenotrecommended由于高耐药性和不安全的，不推荐磺胺类或氯霉素2023/4/12Shigellosis26RehydrationTreatment补液处理Althoughdehydrationisnotacommonfeatureofshigellosisinfection,butifitoccursorthestoolsarewatery,patientsshouldbegiventheoralrehydrationsalt(ORS)recommendedbyWHO/UNICEF(UnitedNation'sInternationalChildren'sEmergencyFund)

虽然脱水不是志贺氏菌感染的共同特征，但如果发生水样便，应给予患者由WHO/UNICEF（联合国国际儿童紧急基金会）推荐的口服补液盐（ORS）Inseveredehydration,intravenousfluidsisrecommended在严重脱水时，推荐静脉输液However,clinicalexperienceindicatesthatORSisbeneficialinallcasesofshigellosisifgivenasroutinefluidintake.

然而，临床经验表明，口服补液盐如果给作为常规液体摄入所有情况下对志贺氏菌是有益的，。2023/4/12Shigellosis27NursesisencouragingpatienttodrinkanORS(OralRehydrationSolution)toimprovedehydration护士在给病人喝ORS（口服补液盐），以改善脱水2023/4/12Shigellosis28Symptomatictreatment对症治疗Abdomenpain:atropine0.5mg,Im腹痛：阿托品0.5mg，Highfeverortoxemia:dexamethasone(DXM)高热或毒血症：地塞米松（DXM）Shock:休克：Higheffectandbroadspectrumantibiotics高效果和广谱抗生素Supplyenoughfluidintravenously供应足够的静脉注射液Drugsthatconstrictthebloodvesselsmaybegiventoboostbloodflowtothebrainorheart(dopamine,10~20µg/kg/min)收缩血管的药物，可给予刺激血液流向大脑或心脏（多巴胺，10〜20微克/千克/分钟）Glucocorticoid(suchasDXMtoreducesymptomoftoxemia)糖皮质激素（如地塞米松，以减少毒血症症状）2023/4/12Shigellosis29Toxicbacillarydysentery

中毒性痢疾Antibioticsadministerintravascularly血管内服用抗生素Anti-shock抗休克Preventandcurehydrocephalus预防和治疗脑积水Dehydrationwith20%mannitol125ml-250ml,q4~12h用20％甘露醇125毫升-250毫升，脱水4〜12小时Inhaleoxygen吸氧Keeprespiratoryfunctionnormal.保持呼吸功能正常。2023/4/12Shigellosis3010.Shigellosis:Prevention

10.志贺氏菌病：预防1.Controlthesourceofinfection.1.控制感染源。

Individualsexcretingshigellaeshouldbeisolatedearlyuntilnegativecultureshavebeenobtainedfromthestoolspecimens.(Carriers!!ignore)产生志贺氏菌的患者，应及早隔离，直到粪便标本的细菌培养中阴性。（携带者!!忽略）2.Cuttingouttheroutoftransmission.切断传播途径Allindividualsexposedtopatientsofshigellosisshouldwashhandwithsoapandwater.接触过细菌性痢疾患者的所有人都应该用肥皂和水洗手。Especiallyfoodhandlers尤其是食品从业人员3.Vaccination?疫苗？NOvaccineavailableinclinicuptonow.在临床上到现在还没有疫苗2023/4/12Shigellosis31Patientxxx,female,25-year-old,messsteward,Suddenlyonset2daysagowithgeneralmalaise,chill,fever,fatigue,headacheandcrampingabdominalpain,especiallyinleftinferiorabdomen,thenfolloweddiarrheawithwaterstoolinitially,andthenbloodypurulentstools,10~20timesperday,accompaniedwithburningsensationatAnus---tenesmus.

Fivedaysagothiswomanhadnursedadiarrheapatient.PE：T39.5℃，R30/m，P110/m，BP110/80mmHg。Press-painontheleftinferiorabdomenReviewtheCasereport

查看病例报告2023/4/12Shigellosis32Bloodtest:WBC12.5×109/L;neutrophilicleukocyte85%Stooltest:WBC50~60/HP，RBC20~30/HP。Questions1.Whatdiseaseisthepatientsufferedfrom?2.Whatistheprincipleoftreatmentforthispatient?(Antibioticsandsymptomatic,supportivetreatment)3.Howtopreventthisdisease?(isolatethepatientandwashinghands)2023/4/12Shigellosis33Amoebicdysentery阿米巴痢疾AmebiasisiscausedbytheprotozoanparasiteEntamoebahistolytica.Cystsshedinhumanfecesmaycontaminatefoodordrinkingwaterorbetransferredsexually,onhands,orfomites.cystsarerelativelychlorine-resistant.Incubationperiodis1-4weeks.Whileintestinaldiseaseisoftenasymptomatic,symptomsmayrangefromacuteabdominalpain,fever,chills,andbloodydiarrheatomildabdominaldiscomfortwithdiarrheaalternatingwithconstipation.Extraintestinalinfectionoccurswhenorganismsbecomebloodborne,leadingtoamebicabscessesintheliver,lungsorbrain.Complicationsincludecolonicperforation.

2023/4/12Shigellosis34Themostcommonlyorderedparasitetest(microscopyo