（优质课件）经典传染病

病原微生物通过一定途径进入易感人群的机体所引起的疾病 并能在人群中传播 流行 1 第一节传染病概论 一病原微生物的传播引起传染病的病原微生物 传染病流行过程 传染源传播途径 消化道 呼吸道 虫媒 接触 母婴易感人群 2 二病原微生物致病机制病原微生物损害宿主细胞方式 1 进入细胞 细胞死亡 2 内 外毒素杀伤细胞 释放酶降解组织 损伤血管引起缺血性坏死 3 引起免疫反应 起防御作用 也可诱发超敏反应 引起组织损伤 一 病毒致病机制只感染特定细胞 3 病毒损伤宿主细胞方式1抑制宿主细胞DNA RNA及蛋白合成 2病毒蛋白插入宿主细胞质膜 损害其完整性 3病毒复制溶解宿主细胞 4在细胞表面表达的蛋白质 引起免疫反应 攻击被感染细胞 HBV 5损伤宿主抗病原微生物能力 HIV T4 机会性感染 6杀死一种细胞 导致依赖此细胞的细胞死亡 7引起细胞增生 转化 HBV HPV EBV 肿瘤 4 二 细菌致病机制细菌黏附 细菌表面黏附素与靶细胞受体结合 细胞内细菌感染 感染上皮细胞 感染巨噬细胞 既感染上皮细胞又感染巨噬细胞 细菌毒素 endotoxin exotoxin内毒素 革兰阴性菌细胞壁外层结构中的脂多糖 外毒素 革兰阳性菌产生 神经毒素 细胞毒素 肠毒素 由A和B两个亚单位构成 三 宿主免疫反应 5 第二节结核病 tuberculosis 1ConceptionChronicgranulomatousinflammationcausedbytuberclebacillitypicallesion formationoflocalizednoduleknownastubercles 6 Etiologicalfactor bacillustuberculosis 人型 牛型抗酸染色阳性 7 tuberclebacilli 8 tuberclebacilli immunofluorescence 9 routeoftransmission 呼吸道 消化道 皮肤等pathogenesy 1 Pathogenicmaterials 与结核杆菌菌体及细胞壁成分有关a lipid cordfactor 破坏线粒体膜 waxD 超敏反应 b lipoarabinomannan 类似内毒素 抑制IFN 激活巨噬细胞 促进巨噬细胞分泌TNF IL 10 plement 起调理素作用 利于细菌摄入但不能杀死 d heat shockprotein 高免疫源性蛋白质 自身免疫反应 e tuberculinprotein 具有抗原性 超敏反应 f caps 与巨噬细胞补体受体CR3结合 细菌识别摄入 10 巨噬细胞 mechanisms 初次感染 未免疫激活 巨噬细胞吞噬 无杀菌活性 吞噬 杀菌活性增强 细胞因子 迟发超敏反应 3 6周产生免疫反应 组织破坏干酪样坏死 肉芽肿 激活巨噬细胞 11 Basicallylesionpathologicchages 1 Exudativechangesdecreasedresistance largenumberofbacillus hypersensitivitySero fibrinousneutrophilcellsmarcrophagesLocationlung pleurae synovium meninges 12 13 2 Proliferativechangesacquiredimmunity resistance smallnumberofbacillustubercle caseousnecrosis epithelioidcell Langhansgiantcell lymphocyte fibroblast 14 35 Caseousnecrosis 15 epithelioidcell lymphocyte Langhansgiantcell fibroblast 16 epithelioidcell Langhansgiantcell 17 Epithelioidcells 18 sizeoftubercle 0 1mm 19 fusiontuberclenodule fusionwith3 4tuberclenodules 20 3 Necrosischangeshugenumberofbacillusandstrongtoxin vehementhypersensitivity lowresistancegross gray yellowish massivecaseation consolidated 21 Caseouspneumonia 22 necrosis 23 Relationshipbetweenimmunestatusofbodyandbasicallypathologicfeatures 24 PathologicStatusofBodyBacillusPathologicChangesImmuneSensitivityNO ToxicityFeaturesExudativeSero fibrinousChangeWeakStrongerLargeStrongorSerousProliferativeTubercleChangeStrongerWeakerLittleWeakernoduleNecrosisCaseousChangeWeakVehementLargeStrongnecrosis 25 TransformatingregulationofbasicchangesofTB healing 1 exudationisabsorbedx ray clinically 2 fibrosis fibrousencapsulationandcalcificationx ray clinically 26 Tuberclenodulessurroundingfibrosis 27 Caseousnecrosissurroundingfibrosis 28 calcification 29 Gettingdeteriorative 1 Infiltrativeprogression producingexudationandcaseousnecrosissurroundingfocusx ray focalmarginisunclearclinically 30 Infiltrativeprogression 31 Solutionandwidespreaddisseminationliquefactionofcaseousnecrosis formingcavityBronchialdissemination formingnewfociIymphaticdisseminationHematogeneousdissemination 32 Tuberclecavity Newfocioftuberculosis Oldfocioftuberculosis 33 2pulmonarytuberculosisClassificationPrimaryandsecondaryPrimarypulmonarytuberculosisfirstinfectionbybacillichildrenoccasionalyouth 34 primarycomplex Ghoncomplex consistedofprimaryfocus Ghonfocus centralcaseousnecrosistubercularlymphangitistubercularlymphadenitis 35 Primaryfocus tubercularlymphadenitis 36 tubercularlymphadeni tis Primaryfocus tubercularlymphangitis primarycomplex 37 Swellingoflymphnodeswithcaseousnecrosis Primaryfocuswithcaseousnecrosis 38 primarycomplex哑铃状阴影 39 cliniccoursefibrosisandcalcificationoffocusin95 ofpatientstuberculosisofbronchiallymphnodeDissemination Spreadbybronchialsystem bloodstreamandlymphvessels 40 Secondarypulmonarytuberculosisreinfectionofbacillimainlyadultmechanisms primaryfocusreactivatingmorethan10yearslaterpresumablygettinglowerofresistanceofpatient 41 DifferentcharacteristicsfromprimarytuberculosisConstantlocalizationoflesionsintheupperpartoflung apicalregionProliferativefeature tuberclessurroundingcaseousnecrosis lesionislocalized Longcourseandcomplexpathologicfeatures 42 PrimaryTBsecondTB Bacillifirstre infectionPatientschildrenadultimmunewithoutbeforewithPathologicprimarycomplexdiverse freshwitholdFeaturelesionslocalizedInitialfocussubpleuralinaboveorbelowapicaloflungportionofupperorlowerPropertyofmainlyexudationmainlynecrosisLesionandnecrosisandgranulomaDissemi mainlylymphchanneldevelopmentinlungnationandbloodstreambybronchiCourseshort healinginmostcaseslong labile therapy 43 1 Focalpulmonarytuberculosisearlylesionnon activativetuberculosisasymptomaticlocus 2 4cminthesubapicalportionofthelungsizeofthefocus 0 5 1cm 44 45 46 Xray 47 2 Infiltrativepulmonarytuberculosisactivatedlesionmainlyexudationlesionwithcentercaseationclinic lowfever nightsweats coughing hemoptysis tirednessx ray withcatkin like cloudingshadowatborderinsubapicalportionoflung 48 InfiltrativeTB 49 InfiltrativeTB 50 InfiltrativeTB 51 outcome 1 therapeuticsintimeexudateabsorbed necrosisandproliferationlesionfiberocalcified 2 tocontinuedevelopmentexpandedcaseationfocus liquefiction drainedoffbybronchi formingacutecavity closurechroniccavitation chronicfibro cavitativepulmonarytuberculosis 52 53 Acutecavity 54 3 chronicfibro cavitativepulmonarytuberculosisoneormorethickwalledcavitationinupperlobeoflungstructureofcavitation internallayer caseousnecrosis middlelayer tuberculargranulationtissue outsidelayer fibroustissue 55 56 thickwalledcavity 57 thickwalledcavity 58 Xray 59 60 61 inthesameoroppositesidesoflungwithdisseminationlesions themoreadownthemorefreshthefociare raisinghavocwithpulmonarytissue extensivefibrosis pleurathickenandconglutinated 62 Chronicfibro cavitativepulmonarytuberculosis 63 outcome 1 sourceofinfection 2 emptysis erosionofthevesselsoncavity 3 pneumothorax pyopneumothorax erosionofthepleurabycaseationincavity 4 throatandintestinalTB 5 chroniccorpulmonale 64 4 CaseouspneumoniadeteriorationandprogressionbyinfiltrativepulmonaryTBordisseminationofbacilliintheacuteandchroniccavityviabronchia alargenumberofexudateandnecrosis classification lobarandlobularcaseouspneumonia 65 lobularcaseouspneumonia 66 lobarcaseouspneumonia 67 Lobarcaseouspneumoniacaseoussero fibrinexudationformedcaseationandacutecavitation 68 Xray 69 sero fibrinexudationandcaseousnecrosis 70 5 tuberculomamainlylocatedinupperlobeoflung Caseationfocusencapsulatedbyfibertissue Sizeoftuberculoma 2 5cmdiameterssingleormultiple forming resectedbysurgery 71 tuberculoma 72 tuberculoma 73 tuberculoma 74 Peripherallungcancer tuberculoma 75 tuberculoma 76 6 Tuberculouspleuritismoist youthSero fibrininflammationwithalittleofpleuralfluid Absorbedbytreatment Morefibrininexudate organization pleurathickeningandadhesiondry 77 结核性胸膜炎胸腔闭塞 78 3hematogenoustuberculosis acutesystemicmiliarytuberculosischronicsystemicmiliarytuberculosisacutepulmonarymiliarytuberculosischronicpulmonarymiliarytuberculosisexrtapulmonarytuberculosis 79 1 acutesystemicmiliarytuberculosis deteriorationandprogressionbyprimarypulmonaryTB alargenumberofbacilli pulmonaryvenoustributary alloverthebody gross microscopy mainlyproliferation clinically 80 miliarytuberculosisofspleen 81 meningealmiliarytuberculosis 82 intestinalmiliarytuberculosis 83 2 chronicsystemicmiliarytuberculosis 急性病程迁延3周以上 或病菌较长时间内少量多次入血 病变性质 大小均不一致 可同时出现增生 坏死及渗出性病变 84 miliarytuberculosisofspleen 85 Chronicmiliarytuberculosisofspleen 86 Chronicmiliarytuberculosisofspleen 87 Chronicmiliarytuberculosisofspleen 88 3 acutepulmonarymiliarytuberculosis 血行播散型肺结核病 干酪样坏死破入较大的静脉 或含菌的淋巴液经胸导管回流到右心 89 90 91 Xray 92 4 chronicpulmonarymiliarytuberculosis 肺外某器官病灶内的细菌入血所致 病程长 病变新旧不等 大小不一 粟米 数厘米 以增生病变为主 93 4extrapulmonarytuberculosis 1 IntestinaltuberculosisClassificationPrimaryandsecondary 94 primarycomplexofintestine 95 回盲部多见 ulcertype morecommoncircularshallowulcer clinic abdominalpain diarrhea dystrophia 96 ulcerativeintestinaltuberculosis 97 ulcerativeintestinaltuberculosis 98 99 proliferationtypeproliferationoftuberculousgranulationtissueandfibroustissuebowelwallthicken intestinalconstriction formingulcerandpolyponthemucosalsurface clinic chronicincompletionintestinalobstruction 100 2 Tuberculousperitonitisyouth appearance onperitoneumdenselycoveredtuberculousnodes moist abundanttuberculousexudationcausingascites dry abundantfibrinexudateorganizationextensiveadhesionofviscera 101 3 Tuberculousmeningitischildrenmorecommon appearance locatedinsubarachnoidspaceofbasalportionsofthebrain forminggray yellowmiliarytuberculousnodusorabundanttranslucentexudateexudateorganizationarachnoidadhesion 102 Tuberculousmeningitis 103 Tuberculousmeningitis 104 4 tuberculosisofgenitourinaryTuberculosisofthekidney 原发性肺结核血道播散所致 20 40岁男性最常见 起始于皮髓质交界处或乳头体内 继发输尿管 膀胱感染 临床 血尿 脓尿 膀胱刺激征 105 Renaltuberculosiswithcaseousnecrosis 106 Renaltuberculosiswithcaseousnecrosisandcavitation 107 Renaltuberculosis 108 tuberculosisofthegenitalsystem 男性 与泌尿系统结核病关系密切 附睾结核最常见 可有结核结节形成 干酪样坏死 女性 多由血道 淋巴道播散 输卵管结核最常见 造成女性不孕的重要原因 109 Tuberculosisofepididymis 110 Tuberculosisofepididymis 111 5 tuberculosisofboneandjoint Thevertebraecolumn mainlythethoracicandlumbarvertebrae isthecommonestsite Thebonesofhip knee ankle elbowandwristcanbealsoinvolved Thisdiseasestartsinvertebralbodyandextendsintothediscspacecausingcollapse 冷脓肿 coldabscess 112 Tuberculosisoftibia 113 Tuberculosisofspine 114 6 tuberculosisofthelymphnode 115 Lymphnodetuberculosis 116 Tuberculosisofbronchiallymphnode 117 Lymphnodetuberculosis 118 第三节伤寒 typhoidfever 119 1conception acuteinfectiousdiseasecausedbytyphoidbacilli typicallesion macrophageproliferationofMPSalloverthebody clinic incidence childrenandyouthcommon 120 2etiologicalfactorandrouteoftransmission etiologicalfactor typhoidbacilli 在含胆汁的培养基中生长较好 antigenof O H Vi widalreaction endotoxin mainlycausativeagent infectionsource patient vector routeoftransmission fecal oral 121 伤寒杆菌 污染饮水或食物 经口胃大部分被胃酸杀灭潜部分进入小肠伏侵入肠壁淋巴组织肠系膜淋巴结期胸导管入血 菌血症 M吞噬 细菌繁殖全身单核吞噬系统 MPS M增生 吞噬细菌大量繁殖细菌 内毒素入血回肠末端全身多器官中毒性损害肿胀胆囊 大量繁殖 败血症 再次进入小肠致敏淋巴组织强烈过敏反应坏死 溃疡愈合 第1周 10天 第2 3周 第4周 注 血中抗体滴度的高低与患者对伤寒杆菌的抵抗力无关 抗菌作用主要依靠细胞免疫 血培养 粪便培养 肥达反应 mechanisms 122 3pathologicalchangesAcuteproliferativeinflammationtyphoidcellproliferation formingtyphoidgranulomaortyphoidnodule rarelyneutrophilexudation 123 typhoidcell 124 typhoidcell 125 126 IntestinalpathologicalchangesTheprincipallesionsarethoseoflymphoidtissueofterminalsmallintestine 1 StageofhyperplasiaofPeyer spatches 2 Necrosisstage 3 Ulcerationstage 4 Healingstage 127 ShowingthehyperplasiaofPeyer spatchesofileum whichisbutton likeelevation 128 129 130 Microscopy 131 132 necrosisstage 133 3 ulcerationstage 134 ulcer 135 pathologicalchangesofotherMPS typhoidcellproliferation formingtyphoidgranuloma celldegeneration focusnecrosis organhyperemiaandswelling 1 mesentericlymphnode 2 liver 3 spleen 4 bonemarrow 90 136 pathologicalchangesofotherorgans 1 Myocardium toxicmyocarditis 2 Kidney 免疫复合物性肾炎 尿培养第3 4周阳性率25 3 Skin rosespotsinthesecondweek 4 Skeletalmuscle showswidespreadfocalnecrosis Zenker sdegeneration particularlyaffectingtheabdominalwallandthighmuscles 5 bile cyst vector 137 4clinicalfeatures1 持续高热2 相对缓脉3 皮肤玫瑰疹4 消化系统症状5 实验室检查 血 骨髓培养 肥达反应 粪便细菌培养 血WBC 138 5complications1 intestinalbleeding intestinalperforation 2 lobularpneumonia 3 other 139 第四节细菌性痢疾 bacillarydysentery 140 1conception acuteinfectiousdiseaseofthecoloncausedbydysenterybacilli typicallesion abundantfibrinexudateandformingpseudomembrane clinic incidence childrenandyouthcommon 141 2etiopathogenisisandrouteoftransmissionetiopathogenisis dysenterybacillus infectionsource patient vector routeoftransmission fecal oral 3pathogenesis exopathic 细菌对黏膜的侵袭力是致病的主要因素 internalcause 机体抵抗力下降 142 dysenterybacilus 污染饮水 食物 胃部分至大肠大部杀灭 侵袭肠粘膜上皮及固有层 大量繁殖 并产生毒素肠炎性反应全身毒血症 Pathogenesis 143 4Pathologicalchangesandclinicaltypes Location colon especiallysigmoidcolonandrectum classification acute chronicandtoxictypes 144 acutebacillarydysentery 1 pathologicfeatures pseudomembranousinflammationandformingpseudomembrane 2 processofpathologicalchanges 急性卡他性炎假膜性炎 典型肠道病变 溃疡形成 地图状 愈合 发病后1周 145 pseudomembranousinflammation Gross showingthepseudomembraneandirregularulcers 146 pseudomembranousinflammation 147 Microscopy Bacillarydysentery 148 149 150 3 Clinicalfeatures toxicsymptomalloverthebodyandintestinalsymptom highfever abdominalpain diarrhea tenesmus complication intestinalbleeding intestinalperforation 151 chronicbacillarydysentery 1 incidence lastingmorethan2months infectedbyS flexneri 福氏菌 2 pathologicalchanges chroniculcers formingpolypi intestinalwallarefibrosis 3 Clinicalfeatures 152 toxicbacillarydysentery 1 Childrenattheageof2 7yearsoldaresensibletothistype mostcasesareresultfromS sonneiandS flexneri 福氏菌 宋内菌 2 clinicalfeatures toxicsymptomalloverthebody 高烧 惊厥 昏迷 呼吸衰竭 循环衰竭 intestinalsymptom 153 钩端螺旋体病 Leptospirsosis 154 一 概述 1 钩端螺旋体 接触皮肤粘膜 全身毛细血管中毒性损害 急性传染病 2 临床特点 轻重差别大 可表现为全身性感染症状及脏器受损症状 出血 黄疸 肝肾功能不全等 3 发病情况 155 二 病因发病学 1 病因 钩端螺旋体 多种血清群 血清型2 发病 钩体 疫水 感染皮肤 粘膜 小淋巴管 血管 血中繁殖 全身毛细血管中毒性损害 继发病变按病变发展分三个阶段 156 早期 败血症期 无明显组织学损伤 但功能改变较显著 中期 败血症伴器官损伤期 伴不同程度器官损害 临床分型无明显器官损害 流感伤寒型有明显器官损害 肺出血型 黄疸出血型 肾功能衰竭型 脑膜炎型 157 后期 恢复期或后发症期 非特异性免疫 特异性免疫 多数痊愈 少数出现后发症 3 发病机制 发病与钩体血清型 毒力大小 数量及机体免疫反应性有关 损害由其产生毒素或毒性代谢产物引起 但毒素性质未明 158 三 病变及临床病理联系 病变 全身毛细血管中毒性损害 微循环障碍 出血 广泛器官变性 坏死及严重功能障碍 炎性反应轻微 159 1 肺 肺出血病变 点状出血 全肺弥漫性出血 肺叶体积 重量 紫红如肝 切面出血性实变 镜下肺泡壁充血 出血 炎性反应不明显 临床特点 咯血 160 肺出血实变 肝细胞索离解 161 2 肝 病变 肿大 质软 色黄 镜下肝细胞水变性 脂变 小叶中央灶性坏死 Disse腔水肿 肝细胞索离解等 临床特点 黄疸 广泛皮肤粘膜出血 162 3 肾 病变 肾肿大 皮质苍白 髓质淤血 镜下肾小管上皮细胞变性 坏死 间质性肾炎 肾小球改变不明显临床 急性肾功能不全 163 4 其它器官 心脏 横纹肌 以腓肠肌病变最明显 NS 脾 淋巴结 肾上腺 164 四 后发症 与迟发性变态反应有关1 眼部病变2 脑动脉炎 165 第六节性传播疾病 sexuallytransmitteddiseases STD 166 淋病 gonorrhea 167 1conception Gonorrheaisapurulentinflammationofmucousmembranesurfacescausedbyasexuallytransmittedmicroorganism Neisseriagonorrhoeae Etiopathogenisis gonorrhoeae humanaretheonlynaturalreservoirforgonococcus Infectionsource patient vector 168 革兰染色 油镜 169 2Pathologicalandclinicalfeaturesacutepurulentinflammation 1 Malegonorrhea theorganisminfectschieflytheurethra Clinical 尿道口充血 水肿 有脓性渗出物从尿道口流出 170 171 172 2 Femalegonorrhea病变累及外阴和阴道腺体 子宫内膜 输卵管和尿道 173 淋病性前庭大腺炎 已形成脓肿 174 新生儿淋球菌性眼结合膜炎 175 尖锐湿疣 condylomaacuminatum 176 1ConceptionCondylomaacuminatumisasexuallytransmittedinfectioncausedbyhumanpapillomavirus HPV Patients 20 40岁青壮年2Etiopathogenisis HPV types6and11 humanaretheonlynaturalreservoirforHPV Infectionsource patient vector 177 3pathologicalchangesLocations 外阴 生殖器 肛门 178 179 180 181 182 183 184 凹空细胞 185 4Clinicalfeatures局部瘙痒 烧灼感 易反复发作 可癌变 186 梅毒 syphilis 187 1Conception SyphilisisachronicvenerealinfectioncausedbyTreponemapallidum Clinicfeatures 病程具长期性 潜匿性 临床症状不一Basicpathologicalchanges 闭塞性动脉内膜炎及血管周围炎 树胶样肿 188 2Etiopathogenisis Treponemapallidum humansareonlynaturalhostsInfectionsources patientTheorganismistransmittedfromduringsexualintercour