儿童结核病课件

儿童结核病结核病儿童结核病IntheworldTBkills2million

peopleeachyearAbout

8million

peoplebecomesickwithTBeachyearBetween2001and2020,nearlyonebillionpeoplewillbenewlyinfected,200millionpeoplewillgetsick,35million

people

willdiefromTB--Ifpresenttrendscontinue.-----WHOIntroduction儿童结核病Onethirdofworld’spopulation,2billionpeople,areinfectedwithM.Tuberculosis.TBInfectionratesarehighestinSoutheastAsia,China,India,Africa,andLatinAmerica.------------16th

NelsonTextbookofPediatrics

Introduction儿童结核病InChinaMorethan330millionpeopleinfectedwithTBMorethan6millionpeoplebecomesickwithTBTBinfectionrateinchildrenis9.6%Introduction▲▲▲儿童结核病March24WorldTBDay世界结核病日Introduction儿童结核病WorldTBDay

24March2001

"DOTS-TBcureforAll"

"DOTS:untraitementantituberculeuxpourtous"儿童结核病StopTB,FightPoverty.WorldTBDay

2002儿童结核病儿童结核病WorldTBDay,March24,2004儿童结核病TBisachronic

contagiousdisease,causedbytuberclebacilli.PrimarypulmonarytuberculosisisthemostcaseofTBinchildren.Definition儿童结核病Etiology

病因儿童结核病Mycobacteriumtuberculosis/结核杆菌Acid-Fastbacillus,AFB(RobertKoch,1882)

抗酸染色为红色---抗酸杆菌M.tuberculosis(人型结核杆菌)&M.bovis（牛型结核杆菌）aretwomainspeciescausingtuberculosisinhuman.儿童结核病儿童结核病儿童结核病Transmission

TBcandevelopafterinhalingdropletssprayedintotheairfromacoughorsneezebysomeoneinfectedwithM.tuberculosis.(主要传播途径为呼吸道)

Transmissionthroughgastrointestinaltractanddirectskincontactisuncommon.（经消化道、皮肤和胎盘少见）儿童结核病

Infants&childrenaremostfrequentlyinfectedbyanadultmemberwhoisanopenactiveTBpatientofthehousehold.

常见的传播源为家庭成员、密切接触的亲属、保姆、邻居，尤其是哺乳期母亲患开放型肺结核。Transmission儿童结核病anopenactiveTBpatientTransmission儿童结核病Pathogenesis

发病机制儿童结核病Acid-Fastbacillus进入体内（胞内寄生）致敏T淋巴细胞（细胞免疫，4~8周）释放cytokines/lymphokines激活macrophages吞噬和杀灭结核杆菌Pathogenesis儿童结核病ImmunityResponseAllergy同一细胞免疫免疫过程中的两种不同表现Pathogenesis儿童结核病InheritancefactorsPathogenesis儿童结核病Diagnosis

诊断儿童结核病DiagnosisSex:female＞maleAge:＜5yrs儿童结核病Diagnosis-----CaseHistoryToxicsymptomsoftuberculousinfection/

结核中毒症状Historyofcontactwithpulmonarypatients/

结核接触史HistoryofBCGvaccination/

卡介苗接种史Historyofotherinfectionillness/

既往病史

儿童结核病Toxicsymptomsoftuberculousinfection

mildfever/低热

nightsweat/盗汗

fatigue/乏力

poorappetite/食欲减退

weightloss/消瘦Diagnosis-----CaseHistory儿童结核病Historyofcontactwithpulmonarypatients

esp.contactwithanopenactivepulmonarytuberculosispatient

Diagnosis-----CaseHistory儿童结核病

HistoryofBCGvaccinationDiagnosis-----CaseHistory

HistoryofBCGvaccinationCheckthescarofBCG/卡痕儿童结核病PastillnesshistoryDiagnosis-----CaseHistory

TBmeasles/麻疹

chickenpox/水痘

etc.儿童结核病因病而异Diagnosis---symptom&sign儿童结核病EtiologydiagnosisCulture&/orsmearofsamplesfortuberclebacilli

gastricwashingorinducedsputum

结核菌检查（查痰液、胃液等）Diagnosis-----AssistedExamination

儿童结核病儿童结核病Pathologydiagnosis

LymphNodespunctureTissueBiopsyFibrobronchoscopeDiagnosis------AssistExamination

儿童结核病

结核性肉芽肿结核特征性病变：中央为干酪样坏死，周围为增生的上皮样细胞，其内散在Langerhans巨细胞。儿童结核病

ImmunologicalExamination

TuberculinSkinTest(PPDorOTtest)/

结核菌素试验

ELISA（PPD-IgM、IgG）Diagnosis------AssistExamination

结核菌素接种后，多长时间观察结果？接触结核后，多长时间结素试验出现反应？儿童结核病Bio-MolecularTechnique

PCR,PolymeraseChainReaction

SouthernBlot

NorthernBlotDiagnosis------AssistExamination

儿童结核病ChestRoentgenography(ChestX-ray)Diagnosis------AssistExamination

儿童结核病结核病的早期诊断最为重要

TBisachroniccontagiousdiseasecausedbytuberclebacilli.

PrimarypulmonarytuberculosisisthemostcaseofTBinchildren.儿童结核病原发型肺结核PrimaryPulmonaryTuberculosis儿童结核病

Primarypulmonarytuberculosis

isthemajortypeofpulmonarytuberculosisdevelopedinchildrenduringinitialinfection.（原发型肺结核是指结核菌初次侵入肺部后发生的原发感染，是小儿肺结核的主要类型，占儿童各型肺结核总数的85.3%。）Definition儿童结核病

Basicpathologicalchanges

Exudation/渗出

Proliferation(tuberculoustubercle,tuberculousgranuloma)

增殖（结核结节、结核性肉芽肿）

Necrosis(caseation)/坏死（干酪性坏死）

Outcomeofpathologicalchanges

FullyRecover(Calcification/Absorption/Fibrosis)ProgressionWorsenPathology儿童结核病特征性病理改变：上皮样细胞结节、Langerhans细胞浸润Pathology儿童结核病ThemanifestationofTBinchildrenarevariable.OnsetofTB,chronic&hiding/起病常隐匿

Asymptomcases80%UpperrespiratorytractinfectionToxicsymptomsoftuberculousinfectionMalnutritionManifestation儿童结核病ThemanifestationofTBinchildrenarevariable.Hypersensitivityerythemanodosum/皮肤结节性红斑

phlyctenularconjunctivitis/疱疹性眼结膜炎

arthritis

/关节炎

Onoccasion,theonsetofTB,abruptLungsymptomsasthmaticbreathing,cough,etc.Manifestation儿童结核病

Superficiallymphnodeswell

Lungsigns

多无明显体征叩诊可为浊音听诊呼吸音减低听诊少许湿罗音Signs儿童结核病Diagnosis

HistoryManifestationsPhysicalexamination

Immunologyexamination

tuberculinskintest/ELISA/etc.

ChestX-ray

examinationFibrobronchoscopeexamination儿童结核病

ChestX-ray

PrimaryComplex(原发综合征)

primaryfocusatthesiteofimplantation/原发病灶

tuberculouslymphangitis/淋巴管炎

regionaltuberculouslymphadenopathy/淋巴结炎

呈典型“哑铃状双极影”Diagnosis儿童结核病原发综合征：哑铃状双极影儿童结核病

ChestX-ray

TuberculosisofTracheobronchialLymphonodus

支气管淋巴结结核Diagnosis表现为：肺门影增浓儿童结核病TuberculosisofTracheobronchialLymphonodus儿童结核病无细菌培养条件下小儿肺结核的诊断标准①有与成人结核、尤其开放结核接触史；②持续两周以上的咳嗽，抗生素治疗无效；③结素试验阳性：无卡介苗接种史者>10mm

有卡介苗接种史者>15mm④符合肺结核诊断的X线征象；⑤抗结核治疗有效（两个月后体重增加10%以上，症状好转）。--------具有以上两点或两点以上条件（供参考）儿童结核病判断小儿结核病具有活动性的参考指标①结素试验≥20mm；②<3岁、尤<1岁未种卡介苗结素试验阳性；③有发热及其他结核中毒症状；④找到结核