儿科教研室麻疹专题课件

1、中南大学儿科教研室麻疹专题中南大学儿科教研室麻疹专题中南大学儿科教研室麻疹专题概述(overview)临床特征为：发热、上呼吸道炎症、结合膜炎、Koplik斑与全身性斑丘疹(clinical features: fever,upper respiratory inflammation, conjunctivitis, Kopliks spots and generalized maculopapular rash) 2通过阅读报刊，我们能增长见识，扩大自己的知识面。中南大学儿科教研室麻疹专题中南大学儿科教研室麻疹专题中南大学概述(overview)临床特征为：发热、上呼吸道炎症、结合膜炎、Ko

2、plik斑与全身性斑丘疹(clinical features: fever,upper respiratory inflammation, conjunctivitis, Kopliks spots and generalized maculopapular rash) 2概述(overview)临床特征为：发热、上呼吸道炎症、病原(ETIOLOGY)麻疹病毒(measles virus)属副粘液病毒，无亚型，仅一种抗原型( RNA-containing virus of the Paramyxovirus family ,only one serotype) 3病原(ETIOLOGY)麻疹病

3、毒(measles viru病原(ETIOLOGY)麻疹病毒(measles virus)麻疹病毒不耐热，对日光和消毒剂均敏感，但在低温中能长期保存(Measles virus are rapidly inactivated by heat,light , and all kinds of desinfectant,but can be stored indefinitely at low temperature)。4病原(ETIOLOGY)麻疹病毒(measles viru病原(ETIOLOGY)麻疹病毒(measles virus)存在于患者前驱期和出疹期的眼结膜、鼻、咽、气管等分泌物中(

4、During the prodromal period and eruption period,it is found in sections of conjunctiva, nose , pharynx ,trachea and so on)。5病原(ETIOLOGY)麻疹病毒(measles viru麻疹的发病机制 鼻、咽 短期繁殖病毒 局部粘膜 血流 远处器官单核 眼结膜 （第一次） 巨噬细胞系统 潜伏期大量繁殖 局部症状 血流 （第二次） 前驱期 全身症状 6麻疹的发病机制 6病理(PATHOGEY)全身淋巴组织增生，有多核巨细胞形成 (Hyperplasia of all lymph

5、oid tissue usually occurs,multinucleated giant cells may be found )7病理(PATHOGEY)7病理(PATHOGEY)多核巨细胞(multinucleated giant cells)：多个巨噬细胞融合形成的具有核内外包涵体的巨细胞网状内皮巨细胞也称华-佛细胞（reticuloendothelial giant cells or Warthin-Finkeldey cells)：存在于全身淋巴组织和肝、脾等脏器中上皮巨细胞（epithelial giant cells）：主要位于皮肤、眼结合膜、呼吸道和消化道粘膜等处 8病理(

6、PATHOGEY)多核巨细胞(multinucleat病理(PATHOGEY)皮肤、眼结合膜、鼻咽部、支气管、肠道粘膜等处可见单核细胞增生与围绕在毛细血管周围的多核巨细胞，淋巴样组织肥大(Prolifieration of mononuclear cells is found in the skin,in the conjunctivae and in the mucous membranes of the nasopharynx, bronchi, and intestinal tract,multinucleated giant cells occur around the capilla

7、ries. Hyperplasia of lymphoid tissue occurs.)9病理(PATHOGEY)皮肤、眼结合膜、鼻咽部、支气管、肠道病理(PATHOGEY)颊粘膜下层的微小分泌腺发炎，其病变内有浆液渗出与内皮细胞增殖形成Koplik斑 (An inflammatory reaction occurs in the fine secretor of the buccal mucosa, where serous exudate and proliferation of endothelial cells result in Kopliks spots) 10病理(PATHOG

8、EY)颊粘膜下层的微小分泌腺发炎，其病变内病理(PATHOGEY)麻疹引起的间质性肺炎为Hecht巨细胞肺炎 (Interstitial pneumonitis resulting from measles virus takes the form of Hecht giant cell pneumonia)11病理(PATHOGEY)11病理(PATHOGEY)麻疹皮疹的病理改变：真皮毛细血管内皮增生、血浆渗出、红细胞相对增多形成淡红色斑丘疹(Maculopapular rash consists of proliferation of capillary endothelial cells

9、 in skin,serous exudate and relative increase of red cells)疹退后，表皮细胞坏死、角化形成脱屑。皮疹处红细胞裂解，疹退后形成棕色色素沉着。12病理(PATHOGEY)麻疹皮疹的病理改变：真皮毛细血管内皮典型麻疹(Typical measles)潜伏期(Incubation stage)一般为1014天(亦可短至1周)，此期可有轻度体温上升(It lasts usually 1014 days after contact,maybe as short as 1 week.The temperature may increased slig

10、htly)。 临床表现13典型麻疹(Typical measles)潜伏期(Incub典型麻疹前驱期 (Prodromal stage)指从发热至出疹,一般为3-4天(from fever to rash appearance,usually lasts 3-4 days) 临床表现14典型麻疹前驱期 (Prodromal stage)临床表现1典型麻疹 主要表现：发热、上呼吸道炎症、眼结合膜炎、Stimson线(fever,upper respiratory inflammation, conjunctivitis ) 麻疹粘膜斑(Kopliks spots)前驱期 (Prodromal s

11、tage)临床表现15典型麻疹 主要表现：发热、上呼吸道炎症、眼结合膜炎、SKopliks spots(麻疹粘膜斑) 时间：发疹前24 48小时出现(24-48 hours before the appearance of the rash)；位置：开始对着下臼齿的颊粘膜上；以后累与整个颊部并蔓延至唇部粘膜(initially opposite the lower molars but may spread the rest of the buccal and lip mucosa)。临床表现16Kopliks spots(麻疹粘膜斑) 时间：发疹前Kopliks spots(麻疹粘膜斑)形态

12、：直径约1的灰白色小点，外有红晕(grayish white dots with 1mm in diameter,usually as small as grains of sand,that reddish areolae)；发展：1天内很快增多，皮疹出现后逐渐消失(They spread rapidly within one day and disappear gradually after the appearance of the rash)。临床表现17Kopliks spots(麻疹粘膜斑)形态：直径约11818典型麻疹出疹期 (eruption stage) 在发热3-5天后出现

13、,持续3-5天 出疹顺序:耳后、发际额、面部颈躯干四肢,达手掌、足底 (initially occurring behind the ears and hairline and spreading down from the forehead and face to neck ,the trunk and the extremities). 临床表现19典型麻疹出疹期 (eruption stage) 临床表现1典型麻疹出疹期 (eruption stage)皮疹性质:红色斑丘疹，疹间皮肤正常(red maculupapular rash, there is normal skin among

14、 rashes.)临床表现20典型麻疹出疹期 (eruption stage)临床表现202121典型麻疹 恢复期(convalescent period) 皮疹按出疹先后顺序消退,伴有糠麸样脱屑与棕色色素沉着,经710天消失(The rash fades downward in the same sequence in which it appeared .As the rash fades , branny desquamation and brownish discoloration occur and then disappear within 7-10 days)临床表现22典型麻疹

15、 恢复期(convalescent period 并发症(complications)肺炎(pneumonia) 是麻疹常见的并发症，多见于出疹期，继发细菌或其它病毒感染喉、气管、支气管炎(laryngitis,trachitis, bronchitis)心肌炎(myocarditis) 23 并发症(complications)肺炎(pneumoni并发症(complications)麻疹脑炎与亚急性硬化性全脑炎（measles encephalitis and subacute sclerosing panencephalitis 简称SSPE)结核病恶化(tuberculosis exa

16、cerbating)营养障碍与维生素A缺乏症(malnutrition and vitamin A deficiency)24并发症(complications)麻疹脑炎与亚急性硬化性全诊 断(DIAGNOSIS)麻疹接触史(exposure to measles previously)典型临床表现(typical clinical manifestations)25诊 断(DIAGNOSIS)麻疹接触史(exposure 诊 断(DIAGNOSIS)前驱期鼻咽部找多核巨细胞与尿中检测包涵体细胞(During the prodromal stage, multinucleated giant

17、cells are found in nasopharynx,intrancuclear and intracytoplasmic inclusion bodies cells are found in urine)26诊 断(DIAGNOSIS)前驱期鼻咽部找多核巨细胞与尿中诊 断(DIAGNOSIS)ELISA法检测麻疹抗体(Measles virus antibodies become detectable by ELISA when the rash ppears;testing of acute and convalescent sera shows the diagnostic s

18、eroconversion or fourfold increase in titer)27诊 断(DIAGNOSIS)ELISA法检测麻疹抗体(Me鉴别诊断病原全身症状和其他特征皮疹特点发热与皮疹的关系麻疹(rubeola)麻疹病毒卡他症状结膜炎、发热Koplik斑红色斑丘疹，特别的出疹顺序，退疹后有色素沉着几细小脱屑发热34天，出疹时体温更高风疹(rubella)风疹病毒耳后、颈后、枕后淋巴结肿大退疹后无色素沉着及脱屑发热半天或一天后出疹幼儿急疹exanthema subitum 人疱疹病毒6型一般情况好，耳后、颈后、枕后淋巴结可肿大颈及躯干部多见，一天出齐，次日消退高热35天，热退疹出猩

19、红热(scarlet fever)乙型溶血性链球菌高热，中毒症状重，咽峡炎、杨梅舌、环口苍白圈、扁桃体炎皮肤弥漫充血，密集针尖大小丘疹，1周后全身大片脱皮发热12天出疹，出疹时高热28鉴别诊断病原全身症状和其他特征皮疹特点发热与皮疹的关系麻疹(麻疹的流行病学与预防 流行病学(epidemiology) 传染源：急性期患者和亚临床型带病毒者 预防(prevention)控制传染源：隔离患者： 出疹后天，并发肺炎者10天。 接触过麻疹的易感者： 隔离检疫3周29麻疹的流行病学与预防 流行病学(epidemiolo麻疹的流行病学与预防流行病学 传播途径： 主要是呼吸道飞沫传播。预防 切断传播途径：实

20、行“三门”，病人住所、衣物按规定消毒。30麻疹的流行病学与预防流行病学预防30麻疹的流行病学与预防流行病学预防保护易感人群：主动免疫(active immunization)，被动免疫(passive immunization)。易感性: 人类对麻疹病毒普遍易感。易感者： 未曾患过麻疹或未接种过麻疹疫苗者。31麻疹的流行病学与预防流行病学预防易感性:31治 疗(TREATMENT) 无特异抗病毒治疗，只有支持治疗和对症治疗。(There is no specific antiviral therapy ;treatment is entirely supportive and symptomatic treatment)32治 疗(TREATMENT) 无特异抗病毒治疗，只有支持治治 疗一般治疗 给予易消化的富有营养的食物，补充充足水分；保持皮肤、粘膜清洁33治