《基础医学各论3》资料：18传染病-2

1、Infectious Diseases 2,Sexually transmitted diseases, STD,Syphilis 梅毒 Gonorrhea 淋病 Condyloma acuminatum 尖锐湿疣 AIDS,Gonorrhea 淋病,Gonorrhea is supprurative化脓性 inflammation caused by gonococci淋球菌 and is one of the most common 最常见sexually transmitted disease, which has a high prevalence and very strong in

2、fectiousness.传染性强,Source of infection patients and asymptomatic carriers. Routes of infection usually the sexual contacts in the adults, by the indirect contact in the children, in addition, gonococcal infection may be transmitted to the fetus duting delivery through the birth canal, producing neona

3、tal ophthalmitis.,2.Pathology Mainly affected urinary genital system.泌尿生殖系统 Lesions show purulent 化脓性inflammation followed by granulation tissue formation and fibrosis. In the male, the organism infects chiefly the urethra, producing acute urethritis. The prostate, seminal vesicles and epididymides

4、are commonly involved.,In the female, the cervix is the main site of infection, the urethra, Bartholins and Skenes glands and the uterine tubes are commonly involved. About 1%3%of cases, the organisms enter into the bloodstream 淋病性败血症may cause gonococcal endocarditis, arthritisdermatitis syndrome, m

5、eningitis. In fatal cases, diffuse intravascular coagulation(DIC) with the WaterhouseFriderichsen syndrome may occur.,3.Clinical feature Systemic symptoms are usually absent. In men, the common presentation is with dysuria 尿痛 and purulent urethral discharge. In women, cervicitis may produce a vagina

6、l discharge.,4. Complications Sterility man result. In the maleprostate abscess, urethral stricturehydrops of kidney. In the femalean increased rick of ectopic pregnan- cyentry of gonococci into the pelvic peritoneum via the uterine tubes may cause peritonitis.腹膜炎,Gram stain of urethral discharge fr

7、om a patient with gonorrhea淋病. Many Gram-negative diplococci (Neisseria gonorrhoeae) are present within a neutrophil.,Condyloma acuminatum 尖锐湿疣,It is a sexually transmitted, papillotumorlike lesion, caused by human papillomavirus (HPV). HPV (6, 11type), the virus multiply in the epithelium, specific

8、ally in the mature squamous cells, causing cytologic changekoilocytosis. 凹空细胞 Routes of infection resembling those of Gonorrhea. Location of the lesion on any moist, mucosacutaneou suctional region of the external genesis.,Pathology Gross: single or multiple sessile or pedunculated red verruciform e

9、xcrescences.疣状颗粒 Lesions from a few millimeters to several centimeters in diameter.,Microscopically: Hyperplastic epithelium show papillary hyperkeratosis or parakeratosis Koilocytosis凹空细胞(characteristic lesion). Congestion and large number inflammatory cells infiltration beneath the epidermis. Fate

10、: dysplasia canceration,Condyloma acuminatum, The top right shows HPV-6/11 in IHC; The Lower left shows Koilocytosis.,Condyloma acuminatum of the penis,Condyloma acuminatum of the penis. Low magnification reveals the papillary (villous) architecture.,Condyloma acuminatum of the penis. The epithelium

11、 shows vacuolization (koilocytosis), characteristic of human papillomavirus (HPV) infection.,Condyloma acuminatum,1 表皮疣状乳头状增生 2 表皮角化不全角质层增厚 3 棘层增厚 4 基底层增生 5 上皮角延长增宽，假上皮瘤样增生 6 挖空细胞形成 7 真皮血管扩张上移 8 慢性炎细胞浸润,Syphilis 梅毒,Syphilis is an important transmitted disease and also a chronic infectious disease(la

12、te syphilis occurs 4 or more years from the date of infection). At early stage, it may be asymptomatic and at late stage, it may involve many vital organs(such as liver, brain and aorta) with multiple clinical features.,Latent syphilis a specific treponemal 螺旋体 antibody test is positive no clinical

13、features of syphilis and normal cerebrospinal fluid. Over 70% of patients never develop late stage of syphilis: a minority. However, the patients can intermittently seed the blood with treponemes and be capable of causing transfusion输血 and transplacental infection.胎盘感染,1. Etiology and pathogenesis,P

14、athogentreponema pallidum, 苍白螺旋体. T pallidum is a delicate organism, rapidly killed by drying or temperature change. Mucous membranes are the optimal sites of infection. Only directly sexual contact 直接性接触, T pallidum can penetrate intact mucous membranes and abraded skin causing infection. The organ

15、ism has a strong invasiveness.,Treponema pallidum (dark-field microscopy) showing several spirochetes in scrapings from the base of a chancre,Source of infection patients and latent syphilis. Routes of infection 95% of infection through intimate sexual contact, rarely infection through direct contac

16、t (transfusion, kiss,etc)adults syphilis vertical infection through placenta from the mother with syphilis congenital syphilis.,Pathogenesis After infection, invasiveness of spirochaete pallida and host immunologic response determine development and prognosis of the lesions. In the early stage, host

17、 humoral immune responses may produce the antibodies against T pallidum specific antigens plasma cells , infiltrationlesion heals spontaneously. In the late stage, cellular mediated delayed type hypersensitivity granuloma.,Protean manifestations of syphilis,2.Essential pathological change 基本病理变化 Obl

18、iterative endoarteritis and periarteritis 血管炎 Gumma(syphiloma) 树胶肿、梅毒瘤 *A localized destructive granuloma, more common in the liver, bones and testes. *Gross: greywhite, firm and rubbery, irregular lesion from a few millimeters to several centimeter in diameter. *Microscopically: central area of gum

19、matous necrosis, surrounded by epithelioid cells, lymphocytes, numerous plasma cells and fibrosis.,Trichrome stain of liver shows a gumma (scar), stained blue, caused by tertiary syphilis,Showing a gumma (scar) caused by tertiary syphilis in liver,3.Acquired syphilis(adults syphilis) 后天性 Primary syp

20、hilis 第一期梅毒 *The incubation period after infection is 9-90 days, during this time, treponemes multiply locally and spread to lymph nodes and blood. *The first visible lesion is termed the chancre下疳.The chancre appears at the site of initial invasion usually the penis in the male and the vulva in the

21、 female.,Gross: a painless, punchedout ulcer with an indurated base (hard chancre). Its surface exudes a serous fluid containing large numbers of treponemes. Microscopically: the base of chancre consists of chronic inflammatory response with numerous plasma cells and the vascular lesions of syphilis

22、. After to 2 weeks following the chancre painless enlargement of the inguinal lymph nodes may be present. The chancre heals spontaneously in 3-6 weeks.,Syphilitic chancre in the scrotum,Secondary syphilis 第二期梅毒 Usually follows the primary stage after 2-20 weeks It is characterized by fever, generali

23、zed lymph nodes enlargement, a red maculopapular skin rash(syphilis)梅毒疹 and condyloma flat (plaque-like lesion in the perineum) 扁平湿疣 Microscopically: characterized vascular lesions of syphilis and nonspecific chronic inflammatory response spirochetes are present in large numbers Spontaneously resolv

24、e with or without therapy,Tertiary syphilis 第三期梅毒 Appear any time after 4 years following primary infection. Tertiary lesions may occur in any tissue, especially in the cardiovascular(80-85%), central nervous system(5-10%), liver and bones causing extensive destruction and leading to serious damages

25、 of the affected visceral organs.,Neurosyphilis神经梅毒: 1.Chronic meningovascular syphilis 脑膜血管梅毒 Causes a basal chronic inflammation with marked fibrosis and obliterative vasculitis, with large numbers of plasma cells infiltrating the meninges, granulomas are not present. 2.Parenchymatous syphilis: *A

26、ffect the cerebral cortex causing general paresis dementia 麻痹性痴呆 *Affect the spinal cord causing tabes dorsal 脊髓痨 脊髓后索变性,Cardiovascula syphilis 心血管梅毒 *Involvement of the aorta is common *Aneurysms 动脉瘤 Aortic valve incompetence.主动脉瓣膜关闭不全 Myocardial ischemia secondary to coronary ostial narrowing due

27、to aortic fibrosis.,4. Congenital syphilis 先天性梅毒 Intrauterine infection cause disease of varying degree *40% of cases, abortion and intrauterine death of the fetus. *Neonatal or infantile congenital syphilis. *Lesions resembling those of early syphilis in the adult(skin rash and ulcerating patches o

28、n mucous membranes ) and containing numerous spirochetes. *Osteochondritis and perichondritis causing nasal bridge collapse (saddle nose), and tibia (sabre shins). 马刀胫， 马鞍鼻 *Liver involvementhepatic fibrosis. *Pulmonary involvementfibrosis and inflammation of the lungs.,Late childhood congenital syp

29、hilis 晚发性先天性梅毒 *Interstitial keratitis 间质性角膜炎 *Hutchinsons teeth *Nerve deafness 神经性耳聋 Gummas and neurosyphilis may occur in all forms of congenital syphilis, syphilitic aortitis is extremely uncommon Hutchinson triad梅毒三联征: notched central incisors门牙, interstitial keratitis角膜炎 with blindness, and de

30、afness from eighth cranial nerve injury.,Syphilis is divided into three stages, which have distinct clinical and pathologic manifestations.,1. 一期 Chancre下疳/obliterative endoartertis 2-6w 2. 二期 Syphilid梅毒疹/ obliterative endoartertis 8-10w 3. 三期 Gumma 树胶样肿/syphiloma 梅毒瘤 4-5y 心血管 Syphilitic aortitis/ao

31、rtic aneurysm/cor bovinum 中枢神经 Meningovascular syphilis/paretic dementia/tabes dorsalis 肝 Hepar lobatum 骨 Saddle nose,AIDS/HIV 110,Homosexual or bisexual men constitute by far the largest group, accounting for over 50% of the reported cases. This includes 5% who were intravenous drug abusers as well

32、. Transmission of AIDS in this category is on the decline: currently, about 42% of new cases can be attributed to male homosexual contacts. Intravenous drug abusers with no previous history of homosexuality are the next largest group, representing about 25% of infected individuals. They represent the majority of cases among heterosexuals. Hemophiliacs, especially those who received large amounts of factor VIII