大五上师兄总结-2014传染期末复习

第一章principlesofinfectious 第二章viral 第三章Influenza,Avianinfluenza第四章EpidemicHaemorrhagicFever/Hemorrhagicfeverwithrenal 第五章JapaneseB 第六章 第七章ScrubTyphus恙虫病，Cysticercosis囊尾幼虫 第八章 第九章TyphoidandParatyphoid伤 第十章 第十一章Meningococcal 第十二章Septic 第十三章Leptospirosis钩端螺旋体 第十四章 第十五章Amebiasis，Shigellosis志贺菌/Bacillary principlesofinfectious theperiodbetweentheinvasionofthetissuesbypathogenstheappearanceofclinicalfeatures theperiodfromonsetofdiseasestoapparentclinical3、=sequela后遗 bodyfunctionabnormalafterrecoveringofdiseases4、-recrudescence---Thereappearanceofchill,feverandplasmodiuminbloodaftermalariahasbeentreatedtonoapparentsymptomsforseveraldays.Itoccursmainlyin1-4weeksafterrecoveryduetosuppressionoftheimmunesystembyanyofthefourkindsofplasmodiumanditisrepeatable。5、-relapse---Thesymptomsofmalariareappear,suchaschill,fever,sweatetc.afteranti-malariatreatmentwhichisduetothereactivationofbradysporozoiteintheliver.Itisonlycausedbytertianmalariaandovalemalariamainlyin3-6monthsafterrecovery。6CommensalismPathogensliveinthehostbutdon’tinduce7、-机会染opportunisticinfection---Pathogenswithinthehostcaninducepathologicchangesifhostimmunityissuppressedbysomefactors.8、-重复Repeatedinfection---malaria,schistosomiasis，在被某种病原体的基础上再次被同一种病原体。9、-混合（同时）Mixedinfection---同时被两种或两种以上的病原体。10、-Superinfection---Infectionbyonepathogenatthebaisisofanotherpathogen，HBVoverlapHEV。11、Secondaryinfection继发染---HBVfollowingbacilli，在中，发生于12、Primaryinfection染---Primarypathogenscausediseaseasaresultoftheirpresenceoractivitywithinthenormal,healthyhost,andtheirintrinsicvirulenceis,inpart,anecessaryconsequenceoftheirneedtoreproduceandspread.measles,chickenbox。、性疾病municabledisease---Causedby:、chlamydia、richettsia、prion、paasi（helmnthprotozoaorinectommuiabiliywhichdifferentiatesinfectionsfromnon-infectiousdiseasesTransmissionofpathogenicorganismstootherpeople,directlyorindirectly,mayleadtoanepidemic.14、-covertinfection隐染/亚临床---指病原体侵入后，仅诱导机体产生特异性15、=latentinfection潜伏---Afterinfection,pathogensremainlatentinsidethebody.Developclinicalmanifestationswhenthehostimmunityhasbeenimpaired.Pathogensusuallywillnotbeexcretedbythehostduringperiodoflatency.Herpessimplex16、-overt显染apparent/临床---指病原体侵入后，不仅诱导机体产生特异性 18、=Infection---Thecourseofstrugglebetweenpathogensandhumanoranimalbodies19、=sourceofinfection传染源---指病原体已在体内生长、繁殖并能将其排出体外的人和动20Elimination---pathogenswereexcludedoutbyhostnonspecificorspecificimmunitySuchas:HepatitisA。21、=epidemiologicalprocess---是传染病在人群中发生、发展和转归的过程，包括传染源、22、-后免疫Post-infectionimmunity---免疫功能正常的经显性或隐染某种病原23、-verticaltransmissionmothertobaby28、=Sustainedfever稽留热---Differenceofbodytemperaturelessthan1degreecentigradewithin24hours,over39℃.e.g.Secondweekoftyphoid。29、=Remittentfever弛张热---Changeofbodytemperaturemorethan1within24hours,thebaselinehigherthannormal.e.g.30=Intermittentfever间歇热---Fluctuationbetweennormaltemperatureandhighfeverwithin24hours.e.g.Malaria.31、=Relapsingfever回归热---Feverlasting5~7dayswithrelapseafterseveral Relapsingfever,brucellosis.32、-Irregularfever不规则热---Curveofbodytemperatureisirregular.e.g.Brucellosis,33、-Toxemicsymptoms---symptomsbesidefevercausedbymetaboliteofpathogen,includingbacteriotoxin.Generalpresentations:malaise;headache;anorexia、paininmuscles,jointsandbones、disturbanceinconsciousness、Meningealirritation、septicshock、Liverandkidneyfailure,etc.34、Enanthem粘膜疹---Rashonmucousmembranemucosae.gKoplikspotsin35、Exanthem皮疹---Rashonskinsurface,e.gchickenpox36Maculopapularrash斑丘疹---e.gMaculaandpapuleMaculopapuleinmeaslesrosespotsintyphoidfever.-神经性食物---毒素性食物--1、-propertiesofcommunicabledisease①Presenceofallinfectiousdiseasesarecausedbytheirspecificpathogen.②Infectivity:theinfectiousdiseasescanbetransmissibletootherpeaplethroughsomepathways.③Epidemiologicalfeatures:suchasage,sex,season;importedorendemic;sporadic,epidemic,pandemicoroutbreaks.④Post-infectionimmunity:aftertheinfection,thebodyscanformthespecificimmunitytothepathgenthatcausestheinfectiousdisease。chronic;typical,atypical(mild,severe).②Subclinicalinfection:nosymptoms.poliomyelitis.③Carriers:chronic:typhoid.④Infectedanimals:(naturalsource)rabies,（2）Routesoftransmission：①Air,droplets,dusts:e.g.measles,diphtheria②Water,food,flies(fecal-oralinfection):e.g.typhoid,cholera③Fingers,utensils(contactinfection):e.g.shigellosis,influenza.④Arthropods:A.Biologic:intermediatehosts,e.g.mosquitoesinmalaria,chiggersinscrubB.Mechanicalpassivetransfere.gfliesinamebiasis⑤Bloodbodyliquidtransmission，SuchasHBV,HIV⑥Verticaltransmission:mothertobaby⑦Horizontaltransmission:others（3）3、传染病的临床特点①incubationperiod潜伏期：theperiodbetweentheinvasionoftissuesbypathogensandtheappearanceofclinicalfeatures；②prodromalperiod前驱期：fromonsetofdiseasestoapparentclinicalfeatures；③Symptomaticperiod症状明显期：Apparentofclinicalmanifestations.convalescentperiodlightenanddisappearclinicalmanifestations,Lab.Normal⑤sequela后遗症期：bodyfunctionabnormalafterrecoveringof4、-传染病的诊断标准----（1）Clinicalmanifestations：①Modeofonset②Typeoffever③panyingsymptoms:headachemyalgiaarthalgiaetc.SignsskinrashKoplikspoteschar,hemorrhae（2）pidemiologialOccupation,livingenvironmentandlifestyle.Historyofvaccination.④Historyoftransfusionproducts（3Laboratorystooletc.②Detectionandisolationofpathogens：ADirectexamination、B.Culture、CAnimalinoculation、D.SpecificImmunologicaldetection、E.Molecularbiologicassay，③otherexamination：Xray、Isotope、Ultrasound、CT、MRI。5、-传染病的治疗原则----Principlesoftherapy（1）Aimoftreatment:①foralleviationofsymptomsandsigns②forisolationofpatients③Comprehensivetreatmentincludesdrugtherapy,nursingcareandisolation④Payattentiontobothspecificandsymptomatictreatments（2传6Therapeuticmethods----①Generalandsupportivetreatment.②Etiologic(specific)treatment.Symptomatictreatment.Rehabilitationtherapyforsequelae.⑤TraditionalChinesemedicineandacupuncture.7-传染病的预防---（1）Measuresagainstthesourceofinfection：①Reportofcases：KindA:,cholera,smallpox,SARS.<6hs，KindB:AIDS,hepatitis,etc.<12hs，KindC:influenza,mumps,etc.<48hs.②Isolationofpatients③ ofcontacts④Identificationandanimals（2InterruptGeneralhygienicmeasures:Cleandrinkingwatersupply,Foodhygiene,Correctsewagedisposal.②Disinfectionanderadicationofinsectvectors.③Interventionofparasitelifecycles（3）Protectionofthesusceptible (immunoglobulins)，②Protectionfromenvironmentalfactors:e.g.mosquitoesbites。8特殊病症Pathoghomonicsigns----Measles: Scrubtyphus:eschar，Leptospirosis: calfmuscle，Typhoid:rosespots，Cysticercosis:subcutaneousnodules，Hepatoencephalopathy:flaptremor，Shigellosis:mucus-pus-bloodystool，Amebicdysentery:strawberryjam-likestool，Rabies:hydrophobia。9、病原体破坏组织的机制----①Directinvasion,theenzymessecretedbypathogencancausecytolysis,tissuenecrosisandinflammation.②Theactionsoftoxinsandcytokines,thetoxinsandcytokinescouldresultinginsepticshock,disseminatedintravascularcoagulation,DICetc.③Immunopathogenesis,includeimmunosuppression,T-celldestruction,immunecomplexes.Theimmunopathogenesishappenedmorethantheothertwomechanism,butinmostofthecase,wecouldseemorethantwomechanism.10过程中病原体及免疫反应扮演的角色therolesofpathogensandimmuneresponseininfectionprocess----①Invasiveness:adhesion,penetrationability.Shigella②Virulence:toxins,enzymes,andhistolyticability.E.histolytica③Infectiondose:minimaldosethatcancauseaninfectionStyphi④Variability:changeinstructureofthepathogentoevadefromhostimmunity.Influenza。-流行性腮腺炎的检查特点---：56=一老伯，发热，疲劳，头痛，腰痛，腹痛来就诊。一周，少尿4天。查体：体温37.228次每分。结膜充血，咽喉有瘀点，胸壁有红斑，无肝脾肿大，四肢无压痛，无淋肿大，血常规WBC增高，血红蛋白正常，血小板低，肝功异常，BUN上升，CR下降.4周前有野外接触啮齿动物史viral1HBe转换HBeseroconversion---HBeAgsuggestsHBVreplicationandhighinfectivity.TheproductionofHBeAbwiththeHBeAgdisappearingisseroconversion.AfterHBeAbispositive,thereplicationofHBVisstaticandtheinfectivityisratherlow。2coninfection---Twokindsofpathogensinfecttheindividualatthesametime.ForexampleHBVandHDVinfectthepatienttogether.3、Hepaticencephalopathy---centralneuraldysfunctioncausedbyseveredamageoftheliverfunction.Itiscausedbyconsciousdisturbance,flaptremoraswellascoma.2、-重症肝炎severehepatitis的临床表现----①constitutionalandgastrointestinalsymptomsprogressrapidly;severefatigue,liversize essmallerandhepaticodor；②jaundiceprogressesrapidlywithserumbilirubinmorethan171umol/L③A.bleeding:prolongedprothrombintime,PTA<40%;B.neurologicalsymptomsduetocerebraledemaandhighintracranialpressure;C.complicatedinfection:SBP(spontaneousbacterialperitonitis);D.hepaticencephalopathy;E.hepatic-renalsyndrome;F.toxicabdominaldistentionandascites；④foursubtypes:A.acuteliverfailure(fulminanthepatitis,degreeIIHEPwithin2w)B.subacute(15d-26wdegreeIIHEP);C.acute–on-chronicliverfailure;D.chronicliverfailure(basedoncirrhosis)。3、-重症肝炎的诊断（1）ClinicalData：①rapidlyprogressivejaundice,serumμmol/L②theliver essmallerprogressivelywithhepaticodor(肝臭)③bleedingtendency,asterixisinearlystagehepaticcoma,grossdisorientation, puting,dysphoria(烦躁不安),somnolence(嗜睡)hepaticrenalsyndrome:oliguria,anuria,BUNincreasing（24、-重症肝炎的治疗/慢性重型乙型肝炎chronicseverehepatitisB的治疗原 andsupportivetreatment:stayinbedwithintensivecare,avoidgreasyfood,sufficientcarbohydrate,electrolytebalanceandacid-baseequilibrium,sufficientalbumininordertoavoidtoomuchenteralprotein(avoidHEP),maintainpositivenitrogenbalance,bloodvolumeandcolloidpressure,nohepatotoxicityorrenaltoxicitydrugs；②promotionofhepaticcellregeneration:HGF(肝细胞生长因子)orG-I(胰高血糖素-胰岛素)therapy；③preventionofcomplications并发症:hepaticencephalopathy;upperalimentarytracthemorrhage;secondaryinfection;hepaticrenalsyndrome(avoidrenaltoxicitydrugsandlowbloodvolume)；④antiviraltherapy:HBVDNA>=105copies/mLusenucleosides；⑤artificialliversupportivesystem；⑥liver5、-性肝炎的鉴别诊断----①Jaundicecausedbyotheretiologicalagents:hemolyticobstructivejaundice；②Hepatitiscausedbyotheretiologicalagents:infective,chemical,autoimmune,inheritedmetabolicdisorder(Wilson’s)。6、-典型急性黄疸型肝炎acuteicterichepatitis的临床表现----Theacuteicterichepatitiscontainsthreephrases:①prodromalphrase:Asudden(HAV,HEVorinsidiousonset(HBV,HCV,HDV)lasting5-7daysB.constitutionalsymptoms:malaise,fatigue,mildfeversometime,darkurine,;Cgastrointestinalsymptoms:anorexia,vomitingpoorappetite，abdominaldistension,nausea,acheinrightupperabdomen,lossofdesiretosmokeordrink;D.LFTchange:serumALTlevelrisesdramatically.②Jaundicephrase:A.Jaundiceappearsandculminatesoftenin2wafteronset;B.pruritus,tenderliverpalpable;C.othersymptomssubsideafterjaundice;D.serumandurinebilirubinevaluatesandserumALTevaluatesfor2-6w.③convalescentphraseA.symptomsandjaundicegradualresolution;B.Liverreturnstonormalsize;C.serumALTandbilirubindecrease;D.Thisprocessneeds1-2m.

evidecs

（1）Hemolyticjaundice:①predispositionfactors:drugsinfections，②clinicalmanifestations:anemia,flankpain,fever,hemoglobinuria,increasingreticulocyte③mildjaundice,indirectbilirubinpredominantly④disappearsoonafteradrenocorticalhormonetreatment（2）Obstructivejaundice(肝外):①reasons:cystitis,cholelithiasis,pancreaticheadcarcinoma,duodenalampullarycarcinoma,HCC,amoebicabscess②primarysymptomsandsigns③mildliverdamage,distensionofintrahepaticandextrahepaticbileducts④directbilirubinincreasing。9、-的预防①controlthesourceofinfection:AcutepatientsshouldbeisolateduntilHBVcannotbedetected.Theinfectivityofchronicpatientsshouldbeevaluatedandthepatientsshouldreceiveanti-HBVtherapyoncemeetthestandard.Patientswithcurrentinfectionisnotallowedjobslikefoodprocessingandbabysitting.②cutthetransmissionroute:Sterilizinginserviceindustry，Good syringe，Controlbloodandboldproduct，Preventmother-to-infanttransmission；③protectthesusceptiblecrowd：Activeimmunization:vaccineforHBVforpre-exposureprevention，Passiveimmunization:HBIGforpost-exposureprevention。10、-途径TrytodescribethetransmissionofHBVHumanbeingsareinfectedbrokenskinormucusbyHBVthroughbloodorhumorpollutedbyHBV.①mother-to-infant:A.intra-uterusinfectionthroughplacenta;B.perinatalperiod(围产期)isthemostdominantwayofHBVinfection.Infantisinfectedthroughthebrokenskinormucuscontactingdirectlywiththeinfectedmaternalblood,vaginasecretionsandamnioticfluid.;C.post-deliveryinfectionbytheclosedcontact.②boodbloodproductsandbodyfluidbloodtransfusion,injectionoperation,transplantation,dialysis③others:infectionthroughbrokenmucusofGIorrespiratorytractremainsunclarified.、-、cannotexcludeHBVinfection②HBsAb:aprotectiveantibody,meansimmunitytoHBVIfbotharepositive,thismeansthepatientintheconvalescentphraseorthemutationofSgene；①HBeAg:parallelwithHBVDNA,meanstheactivereplicationofHBVandahigh②HBeAb:AfterHBeseroconversion,HBeAgisnegativewhileHBeAbturnstopositive.ThismeansthereplicationofHBVisstaticandtheinfectivityisratherlow.①HBcAg:positivemeansanactivereplicationofHBVwithinfectivity;usuallycannotbedetected，②HBcAb:hightiterofIgMisusefulforthediagnosisofacutehepatitisorchronichepatitisactivestage，hightiterofIgGmeanscurrentinfection,usuallycoexistswithHBsAg，lowtiterofIgGmeanspastinfection,usuallycoexistswithHBsAb，IfonlyHBcAb-IgGispositive,thismeanspastinfectionorlowlevelofinfectionespeciallyinhightitercases.12、HBVDNA定量检测的临床意义theclinicalsignificanceoftativedetectionofHBVDNA（1）Itissignificantinestimatingdegreeofviralreplication,infectiousnessandcurativeeffectofanti-viraldrugs（2Diagnosis:①HBVDNAisthemostdirectbasisfortheexistenceofHBV.②HBVDNAisthesymbolofHBVreplication.③HBVDNAisthesymbolofinfectiousness.④Complementarydiagnosisforserologicalmarkers:a.HBeAg(-)oranti-HBe(+),Hepatitisb(mutationinpreCareab.HBeAg(-)Hepatitisb(mutationinSareac.Lowinfectionforexample,b（3reatment:factorindecidingwhethertouseanti-viraldrugs.②Usedforpredictionofcurativeeffect:Generally,curativeeffectofanti-viraldrugsisbetterinpatientswithlowtiterofHBVDNA.UsedforassessmentofcurativeeffectHBVDNAisthemostsensitiveindexinassessingcurativeeffectofanti-viraldrugsatpresent。13、乙型肝炎的临床表现----(1)acutehepatitis；(2)chronichepatitis；(3)severehepatitis；(4)cholestatichepatitis；(5)hepatitiscirrhosis。14、急性无黄疸型肝炎的临床表现(1)theacuteanicterichepatitisisfarmorecommontheictericone.(2)mildclinicalmanifestation,similartosymptomsoficterichepatitisexceptjaundice.(3)recoversoon,thecourseofdiseaseisabout3m.15慢性肝炎的临床表现----①SeenonlyinhepatitisB,CandD, infectionover6months②Severityvariable,3subtypes:mild,typicaland ③monmanifestations:malaise,fatigue,poorappetite, fortinrightupperabdomen④Jaundiceseeninsome⑤Enlargementofliverand/orspleen⑥Spidernaevi,hepaticpaincaseswithlongdiseasehistory⑦AbnormalLFTs:aminotranferase,bilirubin,A/G⑧Extrahepaticdiseases:16、的抗治疗（1）InterferoncaninhibitthereplicationofHBVDNA.HBVreplicationperiod;activestageofhepatitiswithnormallevelbilirubin;lowrationallevelHBVDNAinbloodserum.②Prescription:5millionunitspertime.Intramuscularadministrationeverytwoday.③Course:halfayeartooneyear（2）nucleotideoguescanalsoinhibitthereplicationofHBVDNA,lamivudineiswidelyused.①Indication:strictlymastertheindicationoflamivudine,withtheguidancefromexpertdoctors.Checkliverfunctionanddovirologicalexaminationevery1or2months②Prescription500mgpertime.③CourseatleastoneyearTraditionalChinesemedicine:RadixSophoraeSubprostratae.Injection,4ml/d,acourseof3-6months.(大概)28岁男,半月前劳累饮酒后出现疲乏、厌油……尿色加深，服中成药后无好转，黄疸4*5cm瘀斑。心肺无异常。肝脾未触及，腹部膨隆，移动性浊音(+)，压痛及反跳痛(+)。：ALT13__._?,ALB34._?,AFP107.2?,PTA33%,HBsAg、HBeAg(+),HBV第三章Influenza,Avianinfluenza1、Influenza---Acuterespiratoryillnesscausedbyinfluenzaes.Typicalsymptoms-feverchills,myalgia,headache,sorethroat,cough.Seriouscasesinyoungchildrenandelderly.2、Reye'ssyndrome---Influenzacausesfattyliverwithminimalinflammation,andsevereencephalopathy(withswellingofthebrain).Thelivermay eslightlyenlargedandfirm,andjaundiceisnotusuallypresent.days（2ypicalofsystemicsymptoms：Headache,fever,chills,myalgia,ormalaise.respiratorytractsigns,particularlycoughandsorethroat.②Ocularsignsandsymptomsincludepainonmotionoftheeyes,photophobia,andburningoftheeye.③examinationofthepharynx:severesorethroat.injectionofthemucousmembranesandpostnasaldcervicallymphadenopathy.④Chestexamination:largelynegative.rhonchi,wheezes,andscatteredrales.lastfor4-7days.（3）Primaryinfluenza onia:persistentfever,dyspnea,andeventualcyanosis.Sputumproductionisgenerallyscanty.Cardiacfailure,liverfailureandrenalfailure.Physicalfindings:noconsolidationsigns.Mildforminfluenza（5）OtherformsStomachflu、Encephalitistransversemyelitis2、流感的治疗----①Generalmanagement:bedrestandintakeenoughwater,supplementoxygenandfluidtotheseverelyillpatients.②Managementsforthesymptoms:drugsforlowerbodytemperature,painmanagement,coughsuppressandeliminatethesputum.③Antiviraltreatments:giveAmantadinetheatthebeginning.④Antibacterialtreatmentstothepatientswhohavesecondaryinfection.3、高致病性的治疗highpathogenichumanavianinfluenza----Atthebasicofquarantination、symptomstreatment、anti-treatment,weshoulddo:①enhancenutrientsupplement；②enhanceblood-gassurveillanceandrespirationsupplement;③preventandtreatsecdonarybacteriainfection；④preventandtreatothercompliancewithmesuressuchasusingcorticosteroidforimprovingtoxicemiaandrespirationdystressinshortcourse。第四章流行性热EpidemicHaemorrhagicFever/Hemorrhagicfeverwithrenalsyndromes1、=Petechia瘀点---isasmall(1-2mm)redorpurplespotonthebody,causedbyaminorhemorrhage(brokencapillarybloodvessels).SeeninHemorrhagicfeverwithrenalsyndromes、denguefever。2HFRSHemorrhagicfeverwithrenalsyndromes，isaninfectiousdiseaseswithnaturalCausedbyHantann,Transmittedbyrat,Characterizedbyfever,hemorrhage,proteinuria,shockandacuterenalfailure。3、Hypervolemiasyndrome---InoliguricstageofHemorrhagicfever,retentionofwaterandsodiumcausesincreaseofbloodvolume,presentingsuperficialvenousengorgement,strongpulseandincreaseofpulsepressureandheartrate.4、ARDS(Acuterespiratorydistresssyndrome)---Itisseverehypoxemiaduetopulmonaryinterstitialedema,presentingprogressivedyspnea,cyanosis,arterialoxygenpartialpressurebelow60mmHg.Itiscommonlyseeninshockstageandoliguricstage.1-Trytodescribethepathophysiologyofhemorrhagefeverwithrenalfunctionfailure病生shock：①Primaryshockoccurinhypertensionphase: andimmuneresponsesmallbloodvesseldamage---permeabilityofvessel↑---plasmaexudation---bloodvolume↓---bloodSecondaryshock:Occurindiureticphasebecauseofefficientbloodvolumedecrease.（2）Hemorrhage：Capillarydamage;Pla etdecreaseanddysfunction;DIC;increasedHeparin-likeanuria（3Acutekidneydamageofsmallvesselandrenaltubule③Renalinterstitialhemorrhageandedema④Renaltissuenecrosis⑤Activationofrenin,angiotensinII⑥Renaltubulewasblockedbyproteinsandcasts。lasts3-7days,Featureofpyrexia:Sustainedfeverorremittentfever②Intoxicationsymptoms:headache,lumbago,orbitalpain;hiccup,vomiting,abdominalpainanddiarrhea③Capillarydamagesigns:hyperemia,Hemorrhage,Exudativeedema④Kidneydamagesigns:proteinuria,sometimeswithcasts,bloodcellsandmembrane-shapedsustance（2）Hypotensie(shock)phase低血压休克期：Occurduringdefeverscencein4to5daysofdiseasescourse,lasts1to3days.Mainsigns:pain.（3OliguricOccurorsoonafterhypotensivephase,in5to8daysofdiseasescourse.lasts2-5days.afewofcases,lastfor10days：Oliguriaoranuria，Uremia，Metabolicacidosisandimbalanceoffluidsandelectrolyte（4）Diretcphase多尿期：Urine3000ml/24h，Occurin9to14daysofdiseasescourse,lastfor1dayorseveralmonthsThreephase(accordingtourinevolumeandazotemiasigns)：①Transitionphase②Earlystageofdiureticphase③Latestageofdiureticphase；3、-流行性热的诊断----（1）Epidemiologicdata：epidemicplace,season,historyofcontactingratsorexcretionandsecretionsofrats（2）Clinicalfeatures：①Pyrexia,“threeaches”,intoxicatingsymptoms②“Threeflush,conjunctivacongestionandedema,hemorrhage③Oliguria,renalregionpainonpercussion④Fivephaseintypicalcase（3Laboratorydata：①proteinuria，membrane-shapedsubstanceinurine.③specific antigenIgMAb，orIgGAbfourtimesincrease，ViralRNAbyRT-PCR.4-肾综热发热期的治疗Treatmentinfebrilephase----Principleoftreatment①Anti-therapy：Ribavirin；②Reduceexudationof symptoms：PhysicalmeasuresForhyperpyrexia，Corticosteroidsforhyperpyrexiaandheavyintoxicatingsymptoms，Anti-vomiting；④PreventingfromDIC：Reducethebloodviscosity，anti-coagulationtherapy。 Principleoftreatment:①Balanceintra-Correctimbalanceoffluidelectrolytes,acid-base，Reducingproteindegradationandcontrolofazotemia，②Diuretictherapy：20%Mannitolsolution，③Catharsistherapyforpreventingfromhypervolemia：inducingdiarrheatotakeoutfluidsbyintestinal，④Dialysistherapyforserious6、肾综热总原则----（1）①Diagnosis,restandtreatmentinearly②Treatmentinnearhospital（2）①Supportivetreatment②Anti-viraltherapy③Symptomatictreatment。7、肾综热休克期的治疗----Principleoftreatment:①Supplementbloodvolume：early,severetoxemia,Reducepermeationofsmallvessel，Improvingmicrocirculationoftissue.8流行性热多尿期的治疗（1）Principleoftreatmentinthetransitionandearlystagediureticphaseissamewitholiguricphase.（2）Inthelatestageofdiureticphase：①Keebalanceoffluidandelectrolytes.②Preventingandtreatmentsecondaryinfection:9、Modesoftransmission----①Air-bornetransmission(most),②Food-bornetransmission,③Infectionviacontact,④Verticaltransmission,⑤Arthropod-borne(Needtobeconfirmed)。Epidemicfeatures----①Districtlocalization:mainlyinAsia,thenEuropeandAfrica,America②Seasonality:NovembertonextJanuaryandMaytoJulytransmittedbyApodemusagrarius)MarchtoMay(transmittedbyhouserats)。10、流行性热的鉴别诊断----①Infebrilephase：withcommoncold,influenza,Septicemia.②InHypotensivephasewithotherinfectionshock③Pyrexia,intracraniahemorrhageandcerebraledemawithmeningococcalmeningitis④OliguriaandrenalfailurewithacutenephritisPyrexiaandhemorrhagewithLeptospirosisMarkedhemorrhagewith:thrombocytopenicpurpura,gastrointestinalbleedingcausedbygastriculcer.-典型的肾病综合征热（少尿期1、诊断及诊断依据（10分2、该病例的治疗原则（15分肾综热JapaneseB1、JapaneseBencephalitis---isadiseasecausedbythemosquito-borneJapanese.Domesticpigsandwildbirdsarereservoirsofthe;transmissiontohumansmaycauseseverecentralnervesystemsymptoms.-Vomiting,Abdominalpain,Drowsy,Neckrigidity,Covulsions,Seizures（）AcuteEncephaliticStage:4-10d.①Highfever:forabout7~10days，②Changesinconsciousness:dullness,tremor,stupor,ataxia,focalordiffuseparalysis,coma，.Convulsions:localizedorgeneralized,Tremorsinfingers,tongue,eyelidsandeyes，④.Respiratoryfailure：highintracranialpressure,edemaofthebrain,herniaofthebrain（with瞳孔和生命体征变化⑤.SignsandsymptomsinCNS:within10d.superficialreflexes↓.Deepreflexes↑andthen↓Meningealirritationsign:Stiffneck,positiveKernig’ssignandpathologicalreflexes.⑥Circulationfailure:rare（3）Theweeks（4Sequela: （1）Materialsofepidemiology：intheepidemicarea,summerormosthappenedinchildrenlessthan10years（2）clinicalmanifestationhighfever,headache,vomiting,disturbanceofconsciousness,convulsions,pathologicalreflexesandmeningealirritation（3laboatoryIgMinserumorCSF，②Definitivediagnosis：isolation:Blood,CSFsample,brain。3----ToxicshigellosisandotherToxicEncephalopathy,CerebralMalaria,Meningococcalmeningitis,Tuberculousmeningitis,FebrileConvulsion,Rey’sSyndrome,4-乙脑的治疗AGeneraltreatment.BSymptomatictreatment:①highfeverPhysicalice,alcohol,coolsaline&Artificialhibernation②Seizureandconvulsions:Sedation,Corticosteroidsmaybeused③Respiratoryfailure:Oxygensupply,artificialrespiration④raisedintracranialpressure:Mannitoliv.drip1mg/Kgevery6~8hrs.⑤Treatmentforconvalescenceand5、-如何预防乙脑----（1）Vector(Mosquito)control：①Eliminatemosquitobreedingareas:Chemicallarvicides,Biolarvicides,EnvironmentalmanagementAdultandlarvalcontrol:Anti-larvaltreatment（2）accination（3）alprotectivemeasures：①Avoidprimemosquitohours:fromdusktodawn②Indoorsprayandfogging:UseofInsecticide。6、-Labinvestigation病例分析----①Peripheralblood ysis:WBC(10~20)X109/L,neutrophilic＞80%②CSFysis:clear,tensionelevated,WBC(50~500)X106/LNeutrophilsmaypredominateinearlyCSFsamplesbutalymphocyticpleocytosisistypicalProteinglucoseandchloridenormallevel→③Serologicaltests:IgMantibody(earlystage)IgGantibody:highspecificity,peakat5-6weeks.④isolation。7、乙脑预后----mild&moderate:goodrecovery.Severe&fulminate:20%mortality(centralrespiratoryfailure)。8clinicalcoursecanbedividedintofourphases:①TheProdromalStage：Usuallylastsfortheinitial1to3days.Theviremiaphase.②TheAcuteencephaliticStage：Beginsbythethirdtotenthday.Thesymptomsinclude:Highfever;Changesinconsciousness;Convulsions;Respiratoryfailure;Meningealirritationsign；③TheConvalescenceStage：Usuallylastsforatleasttwoweeks.Defervescenceoffeverandneurologicimprovement④TheSequelaStage：30-50%ofsurvivorsmayhaveneuropsychiatric该病例的诊断及依据（8分该病例的治疗措施（8分脾未扪及，KernigS征阳性，Babinski阳性，白细胞升高，N86%。（乙脑1、-SaddleFever马鞍热---inthesomecaseoftypicaldenguefever,thefeverwillremittonormalafter3-5days,butreplaceagainafter1day。2、=enhancingantibody促进性抗体---It’sthespecificantibodyproducedbytheorganismafterbeinginfectedwiththedengue,whichhasweakneutralizationbutstrongenhancement,itcanenhancesthecombinationbetween andtheFcreceptorlocatedonthesurfaceof4、dengueFever---Anacute,self-limited,febriledisease.Dengue aremaintainedinacyclehumans、Aedesaegypti，prima