




已阅读5页,还剩46页未读, 继续免费阅读
版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
Scrub Typhus (恙虫病) Department of Infectious Diseases, the Third Affiliated Hospital Li Gang Definition Acute febrile infectious disease Caused by Rickettsia tsutsugamushi Transmitted by the bite of chiggers Source of infection: Rats Characterized by fever, eschar, rash, and lymphadenopathy Etiology Intracellular organism Propagated in mice, some cells Antigenically diverse microorganism Common antigen with Proteus OX- K Low resistance Epidemiology Source of infection: Rats Vector: Mite The life cycle: ovum, larva, pupa, naiad and imago Only its larva (chigger) feeding on humans imago larva rat pupa naiadimago ovum larva rat pupa naiad 第一代 第二代 (遗传、传染) The life cycle of mite bite ovum Epidemiology Proliferate in warm, wet environments Both a vector and a reservoir Route of transmission: bite of chigger Susceptibility: universal Immunity: long-lasting immunity against the homologous strains; Partial immunity against the other heterologous strains Epidemiology Other epidemiological features: Geographic distribution: Asian-pacific region Sporadic Seasonal distribution: rainy seasons between May and November Pathogenesis human body rickettsemia eschar local site rickettsia mite vasculitis rats Pathology Basic lesion: inflammation of the walls of the small blood vessels Pathologic findings: eschar, lymphadenopathy, rash, enlargement of spleen and liver Serious pathologic manifestations: myocarditis, meningoencephalitis, pneumonia, interstitial nephritis Clinical manifestations Incubation period: 421 days Sudden onset, High fever: remittent fever accompanied by chill, headache, malaise, prostration, poor appetite. Clinical manifestations Signs of multiorgan damage: Meningoencephalitis: delirium, convulsion, coma, and neck stiffness. Interstitial pneumonia: cough, chest pain, breathlessness. Clinical manifestations Signs of multiorgan damage: Myocarditis: gallop rhythm, poor quality heart sounds, systolic murmurs. Hepatitis: jaundice, hemorrhage. Natural course: 23 weeks. Characteristic manifestations Eschar and ulceration: Characteristic sign. Seen in 36.998 of patients. Generally located in warm, wet, intense smelled areas. eschar eschar ulceration Characteristic manifestations 2. Lymphadenopathy: Enlarged markedly regional lymph nodes near the eschar. Generalized lymphadenopathy. Painful, movable, not purulent. Characteristic manifestations 3. Rash: Appears on the 4th to the 6th day. Beginning on the trunk, spread to the extremities. Maculopapular, congestive, no itching. Lasting 37 days. Seen in 35100 of patients. Characteristic manifestations 4. Splenomegaly and hepatomegaly Splenomegaly : 3050 of patients. Hepatomegaly: 1020 of patients. Complications Pneumonia, myocarditis, hepatitis, DIC. Diagnosis Epidemiologic data History of exposure to endemic areas. Rainy season. Diagnosis 2. Clinical features Abrupt onset of fever. Accompanied with chill, lymphadenopathy, rash, enlargement of spleen and liver. Most characteristic sign: eschar. Therapeutic diagnosis. Diagnosis 3. Lab findings A. Routine lab data: WBC liver enzyme values proteinuria. B. Serological tests Weil-Felix reaction Diagnosis Weil-Felix reaction: Positive result obtained from the 4th day. Higher than 1:160 is suggestive. Available and inexpensive. About 50 of patients have diagnostic titers. Diagnosis Complement fixation test and indirect immunofluorescent antibody test: More sensitive and specific than Weil- Felix reaction. Fourfold or greater increase in convalescence. Rarely used because of the difficult in preparing antigens. Diagnosis C. Isolation of organism Blood inoculating into mice. Organism found in mononuclear cells. Specific test to confirm the diagnosis. Cant give a rapid diagnosis. Diagnosis D. Molecular biologic assays Nucleic acid hybridization and PCR. Great potential for sensitive and specific detection of nucleic acid. Being evaluated. Limitation of technique and facilities conditions. Differential Diagnosis Other rickettsial diseases, typhoid fever, leptospirosis, malaria, dengue, septicemia, influenza Prognosis Fatality rate: 960 without treatment. 5 effective treatment. Treatment Chloramphenicol, tetracycline, doxycycline Chloramphenicol: 1.52g daily, divided into 34 aliquots. Fever abates within 48 hours. Total course: 1014 days. Side effects: suppression of bone marrow and aplastic anemia. Prevention Exterminating the source of infection. Reducing and controlling the vectors. Individual protection: Avoiding contact with mites: the best method. Cysticercosis (囊尾蚴病) Definition and introduction One of parasitic diseases. Caused by the infection with the tissue larvae of Taenia solium. Acquired by ingestion of Taenia solium eggs in contaminated foods. Humans: definite host and intermediate host. Definition and Introduction Human infected with Taenia solium in two forms: intestinal Taenia solium and cysticercosis. Cysticercosis has greater clinical significance. Cysticercosis: human tissue infection with the intermediate cyst forms of pork tapeworm. Cysticercus located in the subcutaneous tissue, muscle, brain. Etiology and Pathogenesis Taenia solium eggs passed out from patients. Eggs taken in by the fecal-oral route. Eggs digested by gastric juice to liberate oncosphere. Oncosphere penetrates the intestinal wall into blood circulation. Located in subcutaneous tissue, muscle, brain. Scolex appears and develops into cysticercus. Etiology and Pathogenesis Cysticercus: Bladder-like, fluid-filled cyst. Containing an invaginated scolex. Surrounded by fibrous capsule. Multiple, 0.52cm in size. Etiology and Pathogenesis Cysticercus: Location in subcutaneous tissue and skeletal muscle to produce minimal, if any, symptoms; Location in brain to have serious effects; Location in substantial to be able to occupy the space to produce the relevant sign; Location in ventriculi to produce cysticercus racemosus. Epidemiology Geographic distribution: Latin America, East Europe, southeast Asia, Africa. Source of infection: patient. Transmission: fecal-oral route. Susceptibility: universal. Clinical Manifestation Depend on 2 factors: The location and number of infecting cysts; If the inflammation exists. Brain cysticercosis: found in 6092% of the total cases. Subcutaneous nodule: found in 2/3 of the total cases. Clinical Manifestation Brain cysticercosis The incubation period: within 5 years. Cerebral cysticercosis Epilepsy: Caused by cysticerci located in the cortex near to the motorium. Always the first and the only symptom. Clinical Manifestation Epilepsy: Multifocal and unstable seizure. 2/3 of the grand mal begin with a local spasm. Petit mal includes sensory and motorial obstruction. Clinical Manifestation Neurosis: May be the only manifestation in patients with cryptogenic cysticercosis. Intracranial hypertension symptoms: vomiting, headache, visual disturbances. Clinical Manifestation Ventricular cysticercosis 10 of brain cysticercosis. Caused by acute obstruction of CSF circulation. Manifest as the valve syndrome (Bruns syndrome ) with intermittent positional severe headache, vomiting, shock. Clinical Manifestation Subarachnoid cysticercosis 10 of brain cysticercosis. Chronic, intermittent meningitis. 3/4 have increased intracranial pressure. Mixed form More serious neuropsychic symptoms. Clinical Manifestation Ocular cysticercosis 1.8 of patients with cysticercosis. Single eye involved. Eye pain, decreasing vision, retinal detachment. Clinical Manifestation Subcutaneous or muscle cysticercosis 2/3 of the patients have nodules. Number of nodules: 11000. More frequently felt on body and head. Generally no symptoms Diagnosis Definitive diagnosis: biopsy of tissue cyst. Clinical diagnosis: History of residence in an endemic area; Clinical manifestation; Plain film, CT, MRI; Suggestive laboratory finding: detection of specific IgG in serum or CSF. Treatment Albendazole 1g daily, 2 aliquots, 10 days, repeat it 2 weeks later. Praziquantel 3g daily, 3 aliquots, 3 days. Treatment Notice when treatment: Patients should be hospitalized during the drug therapy. Epilepsy should be controlled at the same time. Increased intracranial pressure should be decreased. Treatment Notice when treatment: Patients with cysticercosis of the eye should not receive drug therapy until the eye disease has been controlled surgically. Surgery preferential for CSF obstruction. Serious side effects easily occurred in patients with psychiatric changes. Prevention Avoid consuming undercooked pork and contaminated food. Careful personal hygiene. High level of community sanitation. 2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeMbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3B0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z- w&t!qYmVjRgOdL9I6F3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7G4C1z)w&t!pYmVjRgOcL9I6E3B0y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnVkShPdMaJ7F4C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbK8G5D1A-x*t$qZnVkSgPdMaI7F4C0z)v&s!pXmUjRfOcK9H6E2B+y(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0z)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4D1z- w&t!qYmVjSgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5D2A+x*u$rZnWkShPeMaJ7G4C1z)w&t!pYmVjRgOcL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$qZnWkShPdMaJ7F4C1z)w&s!pYmUjRgOcL9H6E3B+y(v%r#oWlTiQeNbK8G5D1A-x*t$qZnVkShPdI6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$qZnWkShPdMaJ7F4C1z)w&s!pYmUjRgOcL9H6E3B+y(v%r#oWlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E2B+y(u%r#oWlThQeNbJ8G5D1A-w*t$qYnVkSgPdLaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeMbJ8G4D1A- w*t!qYnVjSgPdLaI6F3C0y)v&s#pXlUiRfNcK9H5E2A+x(u$rZoWkThPeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3B0y)v%s#pXlUiQfNcK8H5E2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaJ7F4C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeNbJ8G4D1A- w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeI7F3C0z)v&s!pXmUjRfOcK9H6E2B+y(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ7G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z-w&t!qYmVjRgOdL9I6F3B0y(ZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z- w&t!qYmVjRgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5D2A+x*u$rZnWkShPeMaJ7G4C1z)w&t!pYmVjRgOcL9I6E3B0y(v%r#oXlTiQfNbK4D1z-w&t!qYmVjSgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5D2A+x*u$rZnWkShPeMaJ7G4C1z)w&t!pYmVjRgOcL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$qZnWkShPdMaJ7F4C1z)w&s!pYmUjRgOcL9H6E3B+y(v%r#oWlTiQeNb4C1z)w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$qZnWkShPdMaJ7F4C1z)w&s!pYmUjRgOcL9H6E3B+y(v%r#oWlTiQeNbK8G5D2A- x*t$qZnVkShPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E2B+y(qZnWkShPdMaJ7F4C1z)w&s!pYmUjRgOcL9H6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E2B+y(u%r#oWlThQeNbJ8G5D1A-w*t$qYnVkSgPdMaI7F3C0z)#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E2B+y(u%r#oWlThQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeMbF4C0z)w&s!pXmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A- x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeMbJ8G4D1A-w*t!qYnVjSgPdLaI7F3C0u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+y(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ7G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%oWlThQeNbJ8G4D1A- w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(unVjSgPdLaI7F3C0y)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkThLaI7F3C0z)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZoWkThPeMF3C0z)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z- w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK9H5E2A+x(u$rZoWkThPeMbF3C0z)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgPdLaI6F3C0y)v&s#p
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 七年级英语下册 Unit 6 I'm watching TV Section B第4课时(2a-2c)教学设计 (新版)人教新目标版
- 10 在牛肚子里旅行(教学设计)2024-2025学年统编版三年级语文上册
- 2024-2025学年高中历史 第二单元 凡尔赛-华盛顿体系下的短暂和平 第6课 国际联盟教学教学设计 岳麓版选修3
- Unit 1 Home-Reading(教学设计)2024-2025学年译林版(2024)英语七年级下册
- 装饰施工现场安全用电
- 2024秋九年级语文上册 第1单元 3我爱这土地教学设计 新人教版
- 管理学矩阵结构
- 《煎荷包蛋》(教案)-2023-2024学年四年级下册劳动人教版
- 一年级道德与法治下册 第四单元 我们在一起 14 请帮我一下吧教学设计2 新人教版
- 2024-2025学年高中生物 第二章 基因和染色体的关系 第1节 减数分裂和受精作用 一 减数分裂教学设计3 新人教版必修2
- (2024年更新)国家慢性疾病编码新目录
- 治疗室物品分类摆放
- 一次性使用医疗用品管理制度
- 兽医屠宰卫生人员考试题库及答案(415题)
- 商务预算员培训课件
- 物业合同增加人员补充协议书(2篇)
- 房屋中介公司员工管理规章制度
- 餐饮服务电子教案 学习任务3 餐巾折花技能(4)-餐巾折花综合实训
- 先天性唇腭裂与颅面裂的诊断及治疗(口腔颌面外科学课件)
- 醉里乾坤大壶中日月长-初中语文九年级第六单元名著导读《水浒传》整本书阅读精读研讨课 公开课一等奖创新教学设计
- TCECA-G 0310-2024 离网制氢灵活消纳与柔性化工系统开发规范
评论
0/150
提交评论