結(jié)核病總論英文

結(jié)核病總論英文第一頁，共36頁。tuberculosisfactoroftuberculosisincidencerising：HIVspread.TBstrainoccurdrugresistance.fluidpopulationincreasing.ManagementTBpatientnotperfect、preventionandcurenotefficiency.Poverty、populationincreasing.2第二頁，共36頁。etiologyMycobacterium、Acidfastness、G+、aerobe。Growthtorpidity,cultureneed4-6weeks.Typing:humantype、bovinetype、Birdtype、mousetype、mainhumantype。wayofinfection：respirationtract、digestivetrack、skinorplacenta.3第三頁，共36頁。Epidemiology1infectionsources：openpulmonarytuberculosis2routeoftransmission:byrespirationwayordigestiontract.3susceptiblepopulation4第四頁，共36頁。EpidemiologyThefactorsleadChildrenillwithTBContactTBamountsandtoxicity.powerofresistance.hereditaryfactor.5第五頁，共36頁。pathogenesybacterialnumber、toxicity、immunizationconditionCell-mediatedimmunereaction:macrophageswallowTB→antigenpresentationThandmacrophage→IL12→CD+4→TH1-IF-γ→topromotemononuclearcell;togather、activation、proliferationanddifferentiation→toproducealexinandoxidase、digestiveenzyme→tokillTB6第六頁，共36頁。pathogenesyIF-reinforcementCD+8、NKcellsactivitytophagocytosisTB.meanwhiletoleadhistoclasiadelayedallergy:Tcellmedia，macrophagetobeeffectorcell，tokillreinfectionTBandcausecheesynecrosisorholeformationAfterInfectionTB:primarydisease（5%），Secondarydisease（5%）,nottofallillalllive(90%)7第七頁，共36頁。diagnoseObjectivetodiscoverfocal。Definitediseasecharacter、sizewhetherornotdeliverbacterium。8第八頁，共36頁。diagnose1historyTBtoxicsymptomtocontactTBpatientBCGvaccinationacuteinfection:measles，pertussisSupersensitivityerythemanodosum、exanthematousconjunctivitis。9第九頁，共36頁。diagnose2：OTtestagent：1/2000or1/10000PPDdose：0.1ML（OT5U）（or1U）。position：leftforearmpalmarisbelow1/3Infuseintracutaneousform6-10mmhillock。48~72hrobservationreaction。10第十頁，共36頁。diagnosisreaction<5mm(-)≧5mm(+)10-19mm(++)≧20mm(+++)Superreaction:induration、vesic、localulceration(++++)。11第十一頁，共36頁。diagnosissignificancepositivereactionAfterBCGvaccinationOlderchildrenpositivereactionindicatetobeeverinfectedwithTBbefore。InfantneverBCGvaccinationindicatenewinfectionrecent。Strongpositivereaction

indicatethereisactivenessTB.。from（-）to（+）、from<10mmto>10mm,orincrease>6mmbyactivenessTB.。12第十二頁，共36頁。diagnosisnegativereactionneverinfectionTBfirstInfectTBduring4-8weeksfalsenegativereaction，immunefunctiontobepresseddown。WrongwithtestorPPDineffective13第十三頁，共36頁。diagnosisBCGVaccinationandnaturalinfectionpositivereactionconditionResultinfectionBCGvaccinationextent（10~15mm)(5~9mm)tochangeSlowly(7~10d)Faster

2~3ddurationtolastlifetimetolast3~4yearsformDeepred\hardRed\soft14第十四頁，共36頁。diagnosis3：laboratoryexamination（1）findTBspecimen：sputum、gastricjuice、、serouscavityliquid.method：smear、fluorescentstaining、BACTECsystem：culturefor2weeks，testmycobacteriametabolismproduction，todistinguishTBandatypical.mycobacteria.Ltuberclebacterium：mutationTB，form、construction、acid-faststainingdifferentfromcommonTB。Easypassingplacenta，therapeuticinefficacy。15第十五頁，共36頁。diagnosis（2）immunologyandmolecularbiologytestELISA（酶聯(lián)免疫吸附試驗）ELIEP（酶聯(lián)免疫電泳技術(shù)）DNA探針PCR（聚合酶鏈式反應(yīng)）線條DNA探針雜交試驗ESR(血沉)。16第十六頁，共36頁。diagnosis4：chestX-RAYTodefinitefocusofinfectionposition、extent、category、activitycondition。Toevaluateandfollowuptherapeuticefficacy。CTmorecleartofindthefocus、extentandspreadcondition。5：bronchofiberscopycheck：todefiniteEndotrachealmembraneTBandtuberculosisoftrachebronchiallymphnodes。6：lymphnodepuncturesmearorlymphadenbiopsytodiagnosis。17第十七頁，共36頁。tuberculotherapygeneraltreatmentnutrition、totakearest。avoidingtocontactinfectiondisease。PrimarilyTBtreatmentinout-patientclinicandregularityreturnvisit。Reportepidemicsituation。18第十八頁，共36頁。tuberculotherapyTreatmen

targetTokillBacillustuberculosisinfocustopreventdisseminate。therapeuticprincipleearlytreatmentReasonabledosageCombinemedicineRegularitytakedrugtoinsistonwholecourseSegmentingtreatment.19第十九頁，共36頁。tuberculotherapyAnti-tuberculosisdrugsWholegermicide：inacidandalkali，exteriorandinteriorofcellcankillgerm。(INHRFP)Halfgermicide：inacidoralkalienvironmentkillcellinteriororexteriorTB，SM/PZAbacteriostatic：EMB（ethambutol)ETH(ethionamide)20第二十頁，共36頁。tuberculotherapynewantituberculosistoAntidrugresistantRifamate(containINH150mgRFP300mg)Rifater(INH,RFPPZA)olddrugderivant：RifapentineNewchemicals：Dipasic，todelayresistantINHdrugstandardtreatment：refertoasymptomaticprimarilypulmonarytuberculosisusage：INH+RFP±EMBcourseoftreatment9~12month.21第二十一頁，共36頁?；煼桨窽wostagetherapyreferto：activenessprimarilypulmonaryTB:acutemiliarytuberculosis;brainTB;intensificationtherapy：（purpose）Combination3~4germicidedrugsLonger3~4mo、shorter2mo。continuetreatmentstageCombinationtwodrugstokeeptherapeuticeffectfor12~18mo.(longerrang)or4mo.(Short-rang)。22第二十二頁，共36頁?；煼桨竤hort-rangetherapyWHOimportantstrategytocuretuberculosismechanismofactionisfastkillorganisminnercelloroutcell。Tosputumbacterium(-)，recoveryfast，recurrenceless。2HRZ/4HR、2SHRZ/4HR、2EHRZ/4HR23第二十三頁，共36頁。antituberculosisdrugsmedicine

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adversereaction

INH10~20多發(fā)性神經(jīng)炎，肝損害RFP10~15可逆性肝損害，消化道癥狀。尿紅色。PZA20-30肝損害，高尿酸血癥。SM15~20聽神經(jīng)損害,腎損害。EMB15~20球后視神經(jīng)炎。24第二十四頁，共36頁。Tuberculosispreventiontocontrolsourceofinfection：smear(+)patientPervasionBCGvaccination：tohaveaninoculationageisneonate.contraindicationcellularimmunitydeficiencyacuteinfectiousdiseaseconvalescencestageRegioneczemaorgeneralskindiseaseOT（+）25第二十五頁，共36頁。TuberculosispreventionDrugpreventionindication:1Closetocontactopenpulmonarytuberculosisinfamily2lower3yearsinfanthavenotinnoculationBCG;butOT（+）3OTfrom（-）to（+）recently4OT(+)withtoxicsymptom5OT（+）andrecentlyillwithmeaslesorpertussis6OT（+）needlong-termtotakecorticosteroidsorimmunodepressant26第二十六頁，共36頁。TuberculosispreventionApproach1:INH10mg/kgcourseoftreatment6~9mo.Approach2:INH+RFP(10mg/kg)course3mo.27第二十七頁，共36頁。原發(fā)性肺結(jié)核（primarypulmonarytuberculosis)首次侵入肺部發(fā)生的原發(fā)感染原發(fā)綜合癥（primarycomplex)原發(fā)病灶+局部病變淋巴結(jié)+淋巴管支氣管淋巴結(jié)結(jié)核(胸腔內(nèi)腫大淋巴結(jié)結(jié)核)28第二十八頁，共36頁。primarypulmonarytuberculosis病理部位:右側(cè)肺上葉底部、下葉上部基本病變：滲出（炎癥細胞單核細胞纖維蛋白）、增殖（結(jié)核結(jié)節(jié)結(jié)核肉芽腫）、壞死（干酪樣壞死）。炎癥特征：上皮樣細胞結(jié)節(jié)、lange