结核病总论英文

1、2021/3/231我国结核病的疫情状况 WHO 93年宣布“全球结核病紧急状态”,98年又重申遏制结核病的行动刻不容缓。 全球现有结核病人2000万,其中95在发展中国家,每年还会新发生800-1000万肺结核病,其中75的病人年龄在1550岁。如不控制,今后10年还将有9000万人发病。 中国是全球22个结核病高负担国家之一,结核病人数位居世界第二位,仅次于印度. 据调查全国三分之一的人口已感染了结核菌;受感染人数超过4亿,受结核感染人群中有10的人发生结核病2021/3/232tuberculosis factor of tuberculosis incidence rising : H

2、IV spread. TB strain occur drug resistance . fluid population increasing. Management TB patient not perfect、prevention and cure not efficiency. Poverty、population increasing.2021/3/233etiology Mycobacterium 、 Acid fastness、G+、aerobe。 Growth torpidity , culture need 4-6 weeks. Typing : human type 、 b

3、ovine type 、 Bird type、mouse type 、 main human type。 way of infection:respiration tract、digestive track、skin or placenta.2021/3/234Epidemiology 1 infection sources:open pulmonary tuberculosis 2 route of transmission: by respiration way or digestion tract. 3 susceptible population2021/3/235Epidemiolo

4、gy The factors lead Children ill with TB Contact TB amounts and toxicity. power of resistance . hereditary factor .2021/3/236pathogenesybacterial number、toxicity、immunization condition Cell-mediated immune reaction:macrophage swallow TBantigen presentation Th and macrophageIL12CD+4TH1-IF-to promote

5、mononuclear cell; to gather、activation、proliferation and differentiationto produce alexin and oxidase 、 digestive enzymeto kill TB2021/3/237pathogenesy IF-reinforcement CD+8 、NK cells activity to phagocytosis TB. meanwhile to lead histoclasia delayed allergy : T cell media,macrophage to be effector

6、cell,to kill reinfection TB and cause cheesy necrosis or hole formation After Infection TB : primary disease（5%）,Secondary disease （5%）, not to fall ill all live(90%)2021/3/238 diagnose Objective to discover focal 。 Definite disease character、size whether or not deliver bacterium。2021/3/239diagnose

7、1 history TB toxic symptom to contact TB patient BCG vaccination acute infection:measles,pertussis Supersensitivity erythema nodosum、exanthematous conjunctivitis。2021/3/2310diagnose 2 :OT test agent:1/2000 or 1/10000 PPD dose:0.1ML（OT 5U）（or 1U）。 position:left forearm palmaris below 1/3 Infuse intra

8、cutaneous form 6-10mm hillock。 4872hr observation reaction。2021/3/2311diagnosis reaction 5mm(-) 5mm(+) 10-19mm(+) 20mm(+) Super reaction :induration、vesic 、 local ulceration (+)。2021/3/2312diagnosis significance positive reaction After BCG vaccination Older children positive reaction indicate to be

9、ever infected with TB before。 Infant never BCG vaccination indicate new infection recent。 Strong positive reaction indicate there is activeness TB.。 from（-）to（+）、from 10mm ,or increase 6mm by activeness TB.。2021/3/2313diagnosis negative reaction never infection TB first Infect TB during 4-8 weeks fa

10、lse negative reaction,immune function to be pressed down。 Wrong with test or PPD ineffective2021/3/2314diagnosis BCG Vaccination and natural infection positive reaction condition2021/3/2315diagnosis3 : laboratory examination（1）find TB specimen:sputum、gastric juice、C.S.F、serous cavity liquid. method:

11、smear、 fluorescent staining、 BACTEC system:culture for 2 weeks,test mycobacteria metabolism production,to distinguish TB and atypical .mycobacteria. L tubercle bacterium:mutation TB,form、construction、acid-fast staining different from common TB。Easy passing placenta,therapeutic inefficacy。2021/3/2316

12、diagnosis（2）immunology and molecular biology test ELISA（酶联免疫吸附试验） ELIEP（酶联免疫电泳技术） DNA探针 PCR （聚合酶链式反应） 线条DNA探针杂交试验 ESR (血沉)。2021/3/2317diagnosis4 : chest X-RAY To definite focus of infection position 、extent、category、activity condition。 To evaluate and follow up therapeutic efficacy 。 CT more clear t

13、o find the focus、 extent and spread condition。5:bronchofiberscopy check:to definite Endotracheal membrane TB and tuberculosis of trachebronchial lymph nodes。6:lymph node puncture smear or lymphaden biopsy to diagnosis。2021/3/2318tuberculotherapy general treatment nutrition、to take a rest。 avoiding t

14、o contact infection disease 。 Primarily TB treatment in out-patient clinic and regularity return visit 。 Report epidemic situation。2021/3/2319tuberculotherapy Treatmen target To kill Bacillus tuberculosis in focus to prevent disseminate。 therapeutic principle early treatment Reasonable dosage Combin

15、e medicine Regularity take drug to insist on whole course Segmenting treatment.2021/3/2320tuberculotherapy Anti-tuberculosis drugs Whole germicide:in acid and alkali,exterior and interior of cell can kill germ。(INH RFP) Half germicide:in acid or alkali environment kill cell interior or exterior TB,S

16、M /PZA bacteriostatic:EMB（ethambutol) ETH(ethionamide)2021/3/2321tuberculotherapy new antituberculosis to Anti drug resistant Rifamate(contain INH 150mg RFP300mg) Rifater(INH,RFP PZA) old drug derivant:Rifapentine New chemicals:Dipasic,to delay resistant INH drug standard treatment: refer to asympto

17、matic primarily pulmonary tuberculosis usage:INH+RFPEMB course of treatment 912 month.2021/3/2322化疗方案 Two stage therapy refer to:activeness primarily pulmonary TB: acute miliary tuberculosis;brain TB; intensification therapy:（purpose） Combination 34 germicide drugs Longer 34mo、shorter 2mo。 continue

18、treatment stage Combination two drugs to keep therapeutic effect for 1218mo.(longer rang)or 4mo. (Short-rang) 。2021/3/2323化疗方案 short-range therapy WHO important strategy to cure tuberculosis mechanism of action is fast kill organism inner cell or out cell。 To sputum bacterium(-),recovery fast ,recur

19、rence less。 2HRZ/4HR、2SHRZ/4HR、2EHRZ/4HR2021/3/2324antituberculosis drugsmedicine dose adverse reaction INH 1020 多发性神经炎,肝损害RFP 1015 可逆性肝损害,消化道症状。尿红色。PZA 20-30 肝损害,高尿酸血症。SM 1520 听神经损害,肾损害。EMB 1520 球后视神经炎。 2021/3/2325Tuberculosis prevention to control source of infection:smear(+) patient Pervasion BCG

20、 vaccination:to have an inoculation age is neonate. contraindicationcellular immunity deficiencyacute infectious disease convalescence stageRegion eczema or general skin diseaseOT（+）2021/3/2326Tuberculosis preventionDrug prevention indication: 1 Close to contact open pulmonary tuberculosis in family

21、 2 lower 3 years infant have not innoculation BCG; but OT（+） 3 OT from（-）to （+）recently 4 OT(+) with toxic symptom 5 OT（+）and recently ill with measles or pertussis 6 OT（+）need long-term to take corticosteroids or immunodepressant2021/3/2327Tuberculosis prevention Approach 1 : INH 10mg/kg course of treatment 69mo. Approach 2 : INH+RFP(10mg/kg) course 3 mo.2021/3/2328原发性肺结核（primary pulmonary tuberculosis)发综合症（primary complex)原发病灶+局部病变淋巴结+淋巴管 支气管淋巴结结核(胸腔内肿大淋巴结结核)2021/3/2329primary pulmonary tube