结核病总论英文

结核病总论英文第一页，共36页。tuberculosisfactoroftuberculosisincidencerising：HIVspread.TBstrainoccurdrugresistance.fluidpopulationincreasing.ManagementTBpatientnotperfect、preventionandcurenotefficiency.Poverty、populationincreasing.2第二页，共36页。etiologyMycobacterium、Acidfastness、G+、aerobe。Growthtorpidity,cultureneed4-6weeks.Typing:humantype、bovinetype、Birdtype、mousetype、mainhumantype。wayofinfection：respirationtract、digestivetrack、skinorplacenta.3第三页，共36页。Epidemiology1infectionsources：openpulmonarytuberculosis2routeoftransmission:byrespirationwayordigestiontract.3susceptiblepopulation4第四页，共36页。EpidemiologyThefactorsleadChildrenillwithTBContactTBamountsandtoxicity.powerofresistance.hereditaryfactor.5第五页，共36页。pathogenesybacterialnumber、toxicity、immunizationconditionCell-mediatedimmunereaction:macrophageswallowTB→antigenpresentationThandmacrophage→IL12→CD+4→TH1-IF-γ→topromotemononuclearcell;togather、activation、proliferationanddifferentiation→toproducealexinandoxidase、digestiveenzyme→tokillTB6第六页，共36页。pathogenesyIF-reinforcementCD+8、NKcellsactivitytophagocytosisTB.meanwhiletoleadhistoclasiadelayedallergy:Tcellmedia，macrophagetobeeffectorcell，tokillreinfectionTBandcausecheesynecrosisorholeformationAfterInfectionTB:primarydisease（5%），Secondarydisease（5%）,nottofallillalllive(90%)7第七页，共36页。diagnoseObjectivetodiscoverfocal。Definitediseasecharacter、sizewhetherornotdeliverbacterium。8第八页，共36页。diagnose1historyTBtoxicsymptomtocontactTBpatientBCGvaccinationacuteinfection:measles，pertussisSupersensitivityerythemanodosum、exanthematousconjunctivitis。9第九页，共36页。diagnose2：OTtestagent：1/2000or1/10000PPDdose：0.1ML（OT5U）（or1U）。position：leftforearmpalmarisbelow1/3Infuseintracutaneousform6-10mmhillock。48~72hrobservationreaction。10第十页，共36页。diagnosisreaction<5mm(-)≧5mm(+)10-19mm(++)≧20mm(+++)Superreaction:induration、vesic、localulceration(++++)。11第十一页，共36页。diagnosissignificancepositivereactionAfterBCGvaccinationOlderchildrenpositivereactionindicatetobeeverinfectedwithTBbefore。InfantneverBCGvaccinationindicatenewinfectionrecent。Strongpositivereaction

indicatethereisactivenessTB.。from（-）to（+）、from<10mmto>10mm,orincrease>6mmbyactivenessTB.。12第十二页，共36页。diagnosisnegativereactionneverinfectionTBfirstInfectTBduring4-8weeksfalsenegativereaction，immunefunctiontobepresseddown。WrongwithtestorPPDineffective13第十三页，共36页。diagnosisBCGVaccinationandnaturalinfectionpositivereactionconditionResultinfectionBCGvaccinationextent（10~15mm)(5~9mm)tochangeSlowly(7~10d)Faster

2~3ddurationtolastlifetimetolast3~4yearsformDeepred\hardRed\soft14第十四页，共36页。diagnosis3：laboratoryexamination（1）findTBspecimen：sputum、gastricjuice、、serouscavityliquid.method：smear、fluorescentstaining、BACTECsystem：culturefor2weeks，testmycobacteriametabolismproduction，todistinguishTBandatypical.mycobacteria.Ltuberclebacterium：mutationTB，form、construction、acid-faststainingdifferentfromcommonTB。Easypassingplacenta，therapeuticinefficacy。15第十五页，共36页。diagnosis（2）immunologyandmolecularbiologytestELISA（酶联免疫吸附试验）ELIEP（酶联免疫电泳技术）DNA探针PCR（聚合酶链式反应）线条DNA探针杂交试验ESR(血沉)。16第十六页，共36页。diagnosis4：chestX-RAYTodefinitefocusofinfectionposition、extent、category、activitycondition。Toevaluateandfollowuptherapeuticefficacy。CTmorecleartofindthefocus、extentandspreadcondition。5：bronchofiberscopycheck：todefiniteEndotrachealmembraneTBandtuberculosisoftrachebronchiallymphnodes。6：lymphnodepuncturesmearorlymphadenbiopsytodiagnosis。17第十七页，共36页。tuberculotherapygeneraltreatmentnutrition、totakearest。avoidingtocontactinfectiondisease。PrimarilyTBtreatmentinout-patientclinicandregularityreturnvisit。Reportepidemicsituation。18第十八页，共36页。tuberculotherapyTreatmen

targetTokillBacillustuberculosisinfocustopreventdisseminate。therapeuticprincipleearlytreatmentReasonabledosageCombinemedicineRegularitytakedrugtoinsistonwholecourseSegmentingtreatment.19第十九页，共36页。tuberculotherapyAnti-tuberculosisdrugsWholegermicide：inacidandalkali，exteriorandinteriorofcellcankillgerm。(INHRFP)Halfgermicide：inacidoralkalienvironmentkillcellinteriororexteriorTB，SM/PZAbacteriostatic：EMB（ethambutol)ETH(ethionamide)20第二十页，共36页。tuberculotherapynewantituberculosistoAntidrugresistantRifamate(containINH150mgRFP300mg)Rifater(INH,RFPPZA)olddrugderivant：RifapentineNewchemicals：Dipasic，todelayresistantINHdrugstandardtreatment：refertoasymptomaticprimarilypulmonarytuberculosisusage：INH+RFP±EMBcourseoftreatment9~12month.21第二十一页，共36页。化疗方案Twostagetherapyreferto：activenessprimarilypulmonaryTB:acutemiliarytuberculosis;brainTB;intensificationtherapy：（purpose）Combination3~4germicidedrugsLonger3~4mo、shorter2mo。continuetreatmentstageCombinationtwodrugstokeeptherapeuticeffectfor12~18mo.(longerrang)or4mo.(Short-rang)。22第二十二页，共36页。化疗方案short-rangetherapyWHOimportantstrategytocuretuberculosismechanismofactionisfastkillorganisminnercelloroutcell。Tosputumbacterium(-)，recoveryfast，recurrenceless。2HRZ/4HR、2SHRZ/4HR、2EHRZ/4HR23第二十三页，共36页。antituberculosisdrugsmedicine

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INH10~20多发性神经炎，肝损害RFP10~15可逆性肝损害，消化道症状。尿红色。PZA20-30肝损害，高尿酸血症。SM15~20听神经损害,肾损害。EMB15~20球后视神经炎。24第二十四页，共36页。Tuberculosispreventiontocontrolsourceofinfection：smear(+)patientPervasionBCGvaccination：tohaveaninoculationageisneonate.contraindicationcellularimmunitydeficiencyacuteinfectiousdiseaseconvalescencestageRegioneczemaorgeneralskindiseaseOT（+）25第二十五页，共36页。TuberculosispreventionDrugpreventionindication:1Closetocontactopenpulmonarytuberculosisinfamily2lower3yearsinfanthavenotinnoculationBCG;butOT（+）3OTfrom（-）to（+）recently4OT(+)withtoxicsymptom5OT（+）andrecentlyillwithmeaslesorpertussis6OT（+）needlong-termtotakecorticosteroidsorimmunodepressant26第二十六页，共36页。TuberculosispreventionApproach1:INH10mg/kgcourseoftreatment6~9mo.Approach2:INH+RFP(10mg/kg)course3mo.27第二十七页，共36页。原发性肺结核（primarypulmonarytuberculosis)首次侵入肺部发生的原发感染原发综合症（primarycomplex)原发病灶+局部病变淋巴结+淋巴管支气管淋巴结结核(胸腔内肿大淋巴结结核)28第二十八页，共36页。primarypulmonarytuberculosis病理部位:右侧肺上叶底部、下叶上部基本病变：渗出（炎症细胞单核细胞纤维蛋白）、增殖（结核结节结核肉芽肿）、坏死（干酪样坏死）。炎症特征：上皮样细胞结节、lange