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总论1.Outcomeofinfection感染的结局(感染谱infectionspectum)ClearanceofmicrobeCovertinfection(subclinicalinfection)Overtinfection(Clinicalinfection)CarrierstateLatentinfection2.Microbeactivity(Pathogenicity)病原体致病能力Invasiveness:adherence&colonizationVirulenceNumberofmicrobevariability3.ImmunereactionNon-specificimmunity(innatehostdefenses)Naturalbarrier;Placenta,blood-brainbarrier,normalmicrobialfloraPhagocytosis,naturalkillercellsHumoralfactorsComplement,Lysozyme,Cytokines(TNF,Interferon,interleukin)Specificimmunity(adaptiveimmuneresponse)Humoralimmunity-productionofAbImmunoglobulin:IgG,IgM,IgE,IgA,IgDCell-mediatedimmunity(CMI)4.Epidemiology流行过程的基本条件Sourceofinfection传染源:Patient,Carrier,InfectedanimalModeofspread传播途径:Contacttransmission,Air-borne,Foodwaterborne,Insectsborne,Bloodandtheirproductsborne,SoilborneSusceptibilitytoinfection人群易感性5.Characteristicofinfectiousdisease传染病基本特征Microbe(Pathogen):病原体Virus,Bacteria,Chlamydia,Rickettsia…Infectivity传染性Epidemiologicalfeatures流行病学特征Postinfectionimmunity感染后免疫Regularityinthedevelopmentofcourse6.病程发展的阶段性Incubationperiod潜伏期Prodromalperiod前驱期:influenza-likesymptomsPeriodofapparentmanifestation症状明显期Convalescentperiod恢复期:Relapse;Recrudescence7.Commonsymptomsandsigns常见症状与体征Fever发热Rash(eruption)出疹Toxemicsymptoms毒血症状:influenza-likesymptomMononuclearphagocytesystemreactions单核巨噬细胞系统反应(在病原体及其代谢产物的作用下,单核吞噬系统可出现充血,增生等反应,临床上表现为肝脾和淋巴结肿大)Formsofthedisease:acute,subacute,mild,common,severe,fulminant,typical,atypical,abortive,ambulatory8.DiagnosisofinfectiousdiseasesEpidemiologicaldatesClinicalfeaturesLaboratoryfindingsRoutineexaminationofblood,urine,fecesIsolationofmicrobialBio-chemicalexaminationsSerologicaltestMolecularbiologicaltestEndoscopeexaminationsImageexaminations9.TreatmentforinfectiousdiseaseGeneralandsupportingtherapy:Isolationofpatients,rest,diet,nursingPathogenicorspecifictherapySymptomatictherapyRehabilitationChineseherbsortraditionmedicine10.PreventionofinfectiousdiseaseManagementofsourceofinfectionCutoffofrouteProtectsusceptiblepopulation:ActiveimmunizationPassiveimmunizationPreventivedrugtherapy一.痢疾病例Jun-10-2014Boy,2years.Feveranddiarrhea1day,comahalfhourT39℃,stoolmixedwithmucusblood,pusBP50/20mmHg,R40,unequalpupil概述Acuteinfectiousdiseaseofintestine;CausedbydysenterybacilliPlaceoflesion:sigmoid&rectumPathologicalfeature:diffusefibriousexudativeinflammationClinicalmanifestation:fever,abdominalpain,diarrhea,tenesmus,stoolmixedwithmucusblood,&pus.evencompaniedwithshockandtoxicencepholopthy1.流行病学Sourceofinfection:patientsandcarriersRouteoftransmission:fecal-oralrouteEpidemicfeature:season:summer&fallFlexneri,Soneii,age:youngerchildren2.临床表现Incubationperiod:1-2day,(hoursto7days)(1)急性痢疾Acutedysentery△commontype:♦acuteonset,shiver颤抖,highfever;abdominalpain♦diarrhea:stoolmixedwithmucus,blood&pus;tenesmus里急后重,△mildtype:♦causedbyS.sonnei♦lowfeverornofever;abdominalpainismild♦stoolmixedwithmucus,withoutblood&pus♦diagnosisbyisolationbacteria△toxictype:♦age:2to7years.♦abruptonset,highfever,T40oC♦convulsionrepeatedly,alteredconsciousness♦circulatory&/orrespiratorycollapse♦diarrheamildorabsentatbeginningshockform:septicshockbrainform:listlessness,lethargy,convulsion,coma.respiratoryfailuremixedform(2)慢性痢疾chronicdysentery:2months慢性迁延型*chronicdelayedtype:long-timediarrheaandrepeated慢性隐匿型*chronicobscuretype:acutehistoryin1year,nosymptoms,stoolculturepositiveorsigmoidscopy急性发作型*acuteattacktype:sameascommonacutedysentery3.实验室检查Bloodpicture:WBCcountincrease,neutrophilsincreaseStoolexamination:directmicroscopicexamination:WBC,RBC,puscellsbacteriaculturePCR:DNASerologicexamination:Sigmoidoscopy:chronicpatientsshallowulcer;scar;polyp4.诊断DiagnosisEpidemiologicdata:contacthistoryClinicalmanifestation:Laboratoryfindings:5.鉴别诊断Differentialdiagnosis急性菌痢鉴别慢性菌痢鉴别chronicdysentery1)阿米巴痢疾amebicdysentery1)结直肠癌rectal&coloniccarcinoma:Entamoebahistolyticanocureforlong-term,dropofweightofbodystool:reddishbrown,likejamflask-shapedulcer,2)非特异性结肠炎non-specificulcercolitisamebictrophozoitenocureforlong-term,cultureofstoolisnegative2)大肠杆菌,沙门氏菌,病毒sigmoidoscopy:hemorrhage,ulcer,enteritiscausedbyE.Coli,salmonella,virus.X-ray:leadpipeintussusception:3)血吸虫chronicschistosomiasisJaponicajam-likestools,contactwiththecontaminatedwaterabdominalmasshepatomegalyandsplenomegalyabsenceoffeverfoundingtheovumofschistosomiasis中毒性菌痢鉴别toxicdysentery乙脑encephalitisB:24h,highfever,convulsion,comacirculatoryfailure;meningealirritation,stoolexamination;CSF;specificIgM6.治疗(1)Commondysenterygeneraltreatment:isolation,diet,fluidandelectrolytepathogenictreatment:norfloxacin;Ampicillinsymptomatictreatment(2)Toxicdysenterygeneraltreatmentpathogenictreatment:L-ofloxacin:0.2bidivdropcefotaxime:Ampicillinsymptomatictreatment:controlofhighfever,convulsion:subhibernationtreatmentofshock:654-2:1-2mg/kgtreatmentofcerebraledema:20%mannitolrespiratoryfailure(3)chronicdysenterygeneraltherapy:live,avoidoverwork,exercise,diet7.预防Controlthesourceofinfection:untilculturenegativeInterruptingtherouteoftransmission:Protectingthesusceptiblepopula
本文标题:临床医学传染 英文课件总结
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