感染性疾病课件：肠道感染病理

IntestinalCommunicableDiseasesMaincontentsIntestinalInfections:TyphoidFever;BacillarydysenterySystemicFungalInfectionsParasitosis:Amoebiasis;SchistosomiasisBasicpropertiesofcommunicablediseasesInflammation

consistentwiththebasiclawsofinflammation：alteration，exudation，proliferationEpidemiologyofcommunicablediseasesinChinaExtinct：Smallpox、Leprosy、PoliomyelitisControllablewithincreasingincidence：Tuberculosis;Syphilis

New—bornecommunicablediseases：

SARS;H7N9……TyphoidFeverAcutecommunicablediseasecausedbybacillustyphiAcuteproliferativeinflammatoryreactioncharacterizedbyincreaseinmacrophagesinMononuclearPhagocyteSystemandbylesionsoflymphoidtissuesatterminalileum.

Clinicalmanifestations:Persistentfever,bradycardia,hepatosplenomegaly,skinrash(rosespots),andleukopenia.Bacillustyphi(G－)endotoxinFlagella“H”antigenThallus“O”antigenWidalreactionInfectionsources：

patientsandbacteria-carrierRoutesoftransmission：

fecal—oralroutePopulation

Allaresusceptible

andimmunizedfromdiseaseTyphoidfeverPathogensisAdsorptiontointestinalmucosaafterbeingswallowed,drainedbythoraciclymphducttobloodstreamafterinvadingintolymphatictissueofbowel.(bacteremia)multiplyinmacrophagesindifferentorgans.(incubativestage)secondbacteremia(septicemia)，generalizedlesions

(medullary

swellingstage)necrosiscausedbybacteriagettingintointestineagainfromcholecyst

bowelulcercellularimmunityupgradedandhealedgraduallyPathologicalfeaturesAcuteproliferativeinflammationcharacterizedbymacrophagesproliferations

TyphoidcellTyphoidgranuloma

orTyphoidNoduleTyphoidgranulomaPathologicalfeaturesinintestine

MostnotableinlowerpartofileumThecourseofuntreatedtyphoidfeverincludes4stages,eachlastingapproximatelyoneweek:

1）medullary

swellingstage

2）necrosisstage

3）ulcerstage

4）healingstageMedullary

swellingstageMedullary

swellingstageNecrosisstageUlcerstagelesionsintheintestineUlcersofIntestinaltuberculosisHowtodetectpathogensindifferentstages?OtherlesionsinMononuclearPhagocyteSystem

Enlargementoflymphnodes,liver,spleenandbonemarrowOtherlesionsinotherorgansheart—toxicmyocarditisskin—rosespotcholecyst—tocarrybacteriaforalongterm,importantsourceofinfectionkidney—immunecomplexingnephritismuscle—coagulativenecrosis（cerosis）TyphoidrosespotOutcomeandcomplicationsMostcanhealwithstrongimmunity

Complications

Entero-hemorrhageEntericperforationLobularpneumoniaBacillaryDysentery

Acommonentericcommunicablediseasecausedbybacillusdysenteriae

PathologicalchangesaremostlylimitedtodistalcolonCharacterizedbypseudo-membranousinflammationcausedbyfibrousexudations.Clinicalmanifestations:fever，abdominalpain，diarrhea，Stoolwithbloodstainedmucusandpus，andtenesmusInfectionsources：patientsandbacteriacarrierRouteoftransmission:fecal—oral,outbreakepidemicSusceptiblepopulation:children>youth>elderpeople,short-timeandunstableimmunity,relapsePathogenesisBacillusdysenteriaeInvadedirectlyintointestinalmucosainvasivenesskeypointMultiplyinlaminapropriaofmucosaEndo-toxinExo-toxin（Shigella）DestroycellsAbsorptedintobloodtoxinemiaWaterydiarrheaUlcerinmucosaDigestivetractPathologicalchangesMostlyinterminalcolon，severelyinsigmoidandrectum.Clinically,itcanbecategorizedwithacute,chronicandintoxicative

acutecase：pseudo-membranousinflammation，map-likeulcer

chroniccase：＞2months，coexistenceofnewandoldlesions

intoxicative：children,withseveretoxaemiapseudo-membranousinflammationpseudo-membranousinflammation

，map-likeulcerFibrousinflammationManifestationsandoutcomesClinicalmanifestations

intestinalsymptom？Outcomes

AcutecasesmostlyrecoverChroniccasesareaffectedrepeatedlyDeathwouldoccurintoxicativecasesMycosisWeakpathogenicityPredisposingfactors:lowimmunity;opportunisticinfectionChronicwastingdiseaseandimmunodeficientdiseaseLong-termuseofbroadspectrumadrenalcortexhormoneHigh-doseX-rayirradiation、anti-neoplasticdrugandimmunosuppressantsLong-termuseofvenouscatheters,visceralductsandmajoroperationEndocrinedysfunctionsMainlesionsMildnon-specificinflammation－cryptococcusneoformansinbrainSuppurativeinflammation－candidiasis、aspergillosisandmucormycosis…Necrotizinginflammation－aspergillosisandmucormycososGranulomatousinflammation

DiagnosesofmycosisNon-specificityinlesionsDiagnoses:tofindpathogenicfungiinlesions（specialstain）ThrushCandidiasisAspergillosismucormycosiscryptococcusneoformansParasitosisCharacteristicsofparasitosisChronicinflammationCharacteristicsofcommunicablediseasesandepidemicsNeedtodetectparasitesandtheireggsindiagnosis.Eosinophilicabcessandgranulomaaresignificant.Amoebiasis

pathogen：pathogenicentamoebahistolyticaLocations：systemicdiseases

mainlyintestine、liver、lungandbrainlesions:liquefactivenecrosis→ulcerorabscesscystSmalltrophozoitLargetrophozoitIntestinalamoebiasisLocation：cecumand

ascendingcolon，thensigmoidandrectumBasiclesions：degeneratedinflammationmainlywith

tissueliquefactivenecrosisacutestage：flask-shapedulcers

chronicstage：Coexistenceofnewandoldlesions—necrosis,ulcer,scarformationandhyperplasiaofgranulationtissuesflask-shapedulcersAmoebiasisDysenteryPathogensEntamoebahistolyticaShigella

dysenteriaeLocationsCecumandascendingcolonSigmoidcolonandrectumPathologicnatureFocalnecroticinflammationsDisseminatedpseudomembranousinflammationsDepthofulcersDeep,flask-shapedShallow,irregularBorderofulcersUnderminingNon-underminingMucosabetweenulcersNormalInflammatorypseudomembranesGeneralizedmanifestationsMild,feverisinfrequentSevere,feverisfrequentIntestinalconditionsTendernessinrightlowerquadrant,diarrhea.Notenesmus.Tendernessinleftlowerquadrant,diarrhea,andtenesmus.StoolexaminationsFoul-odor;bloody;erythrocytesandtrophizoitsarepresentundermicroscopeStoolwithmucusandpus;bloody;puscellsarepresentundermicroscopeExtra-intestinalamoebiasisAmebicliverabscessAmebiclungabscessAmebicbrainabscessSchistosomiasisPathogen：schistosoma（japonicum）Irntemediatehost：oncomelaniaPathogenesis：mechanicalinjury,allergyEspeciallylesionsinducedbyeggsCharacteristicpathologicalchanges:

necrosis(acuteeggnoduleformation)proliferation(chronicegggranulomaformation)LifecycleAcuteeggnoduleMatureeggRadianteosinophilicmaterialsNecroticmaterialsandmanyeosinophilis（eosinophilicabscess）Chronicegggranuloma

Myracidiumintheeggisdead，lowantigenicityFormationofgranulomaliketuberclesFabriceggtubercleMainaffectiveorgancolonliverspleenlungbrainIntestinalschistosomiasisInvolveinthewholecolon,sigmoidcolon

andrectumarethemostnotableEarlystage：acuteeggnodule，superficialulcersAdvancedstage：Coexistanceofnewandoldlesions;fibrosisofintestinalwallandeggnodules,whichcancausestenosisofintestinallumenandbowelobstructionCaninduceconcurrentcancersHepaticschistosomiasisEarlystage:eggsdepositesatportalareaAdvancedstage:chroniceggnodulesandfibrosis

schistosomalhepaticcirrhosis－therearenopseudolobules－portalhypertensionappearsearlyandsevereBilharzialhepaticcirrhosisPipestemhepaticcirrhosisPortalcirrhosisPseudolobuleandPortalHypertensionPleasesummarizeintestinalcommunicablediseasesregardinglocations,typicallesions,symptoms,complicationsandsoon.FilariasisPathogen：WuchereriaBancrofti（transmittedbyCulex）

BrugiaMalayi