肺炎简介医学知识培训培训ppt课件

肺炎肺炎简简介医学知介医学知识识培培训训肺炎简介医学知识培训1World Infection associated mortality 1997/2002World Infection associated mortality 1997/2002(21,000)(21,000)(282,000)(282,000)(285,000)(285,000)(81,000)(81,000)(745,000)(745,000)(1,124,000)(1,124,000)(2,866,000)(2,866,000)(2,001,000)(2,001,000)(1,644,000)(1,644,000)(3,871,000)(3,871,000)WHO The world health report 2002 dataWHO The world health report 2002 data(140,000)(140,000)(275,000)(275,000)(410,000)(410,000)(605,000)(605,000)(960,000)(960,000)(2,100,000)(2,100,000)(2,300,000)(2,300,000)(2,455,000)(2,455,000)(2,910,000)(2,910,000)(3,745,000)(3,745,000)2002200219971997肺炎简介医学知识培训2World Infection associated morCommunity Acquired Pneumonian nEpidemiology:n n4-5 million cases annually4-5 million cases annuallyn n500,000 hospitalizations500,000 hospitalizationsn n45,000 deaths45,000 deathsn nMortality 2-30%Mortality 2-30%n n1%for those not requiring hospitalization1%for those not requiring hospitalizationn nfewest cases in 18-24 yr groupfewest cases in 18-24 yr groupn nprobably highest incidence in 65 yrsprobably highest incidence in 65 yrsn nmortality disproportionately high in 65 yrsmortality disproportionately high in 65 yrsBartlett.CID 1998;26:811-38.肺炎简介医学知识培训3Community Acquired PneumoniaEpCommunity Acquired PneumoniaAdeel A.Butt,MD#in 1000sIncidence肺炎简介医学知识培训4Community Acquired PneumoniaAdCommunity Acquired PneumoniaAdeel A.Butt,MD#in 1000sMortality肺炎简介医学知识培训5Community Acquired PneumoniaAdn nRisk Factors for pneumonian nageagen nalcoholismalcoholismn nsmokingsmokingn nasthmaasthman nimmunosuppressionimmunosuppressionn ninstitutionalizationinstitutionalizationn nCOPDCOPDn nPVDPVDn ndementiadementiaCommunity Acquired PneumoniaID Clinics 1998;12:723.Am J Med 1994;96:313肺炎简介医学知识培训6Risk Factors for pneumoniaComm何謂肺炎？肺炎的診斷依據？肺炎的定義為何？肺炎是否一定會發燒？不發燒是否就一定不會是肺炎？肺炎的治療？肺炎简介医学知识培训7何謂肺炎？肺炎的診斷依據？肺炎的定義為何？肺炎是否一定會發燒呼吸疾病病程與症狀變化Craig C.Freudenrich,Ph.D.Craig C.Freudenrich,Ph.D.病毒感染呼吸道細胞病毒感染呼吸道細胞被感染的細胞死亡被感染的細胞死亡杯狀細胞分泌黏液杯狀細胞分泌黏液干擾素與細胞酵素干擾素與細胞酵素引起發炎引起發炎死亡的上皮細胞死亡的上皮細胞(病毒病毒)發炎細胞發炎細胞分泌的黏液分泌的黏液鼻咽喉移生的細菌增殖鼻咽喉移生的細菌增殖A.Nasal cavityA.Nasal cavityB.PharynxB.PharynxC.LarynxC.LarynxD.TracheaD.TracheaE.AlveoliE.AlveoliF.Bronchial treeF.Bronchial treeG.DiaphragmG.Diaphragm吸引發炎細胞聚集吸引發炎細胞聚集發燒、喉痛、發燒、喉痛、噴涕噴涕發燒、流鼻水發燒、流鼻水傳傳染染期期痰痰中中耳耳炎炎鼻鼻竇竇炎炎支支氣氣管管炎炎菌菌血血症症病病毒毒血血症症肺肺炎炎膿膿胸胸肺炎简介医学知识培训8呼吸疾病病程與症狀變化Craig C.Freudenric社區性肺炎的病原微生物微生物典型肺炎典型肺炎(細菌細菌)S.pneumoniae S.pneumoniae H.influenzae H.influenzae S.aureus S.aureus GNB GNB Others Others非典型肺炎非典型肺炎 Legionella spp.Legionella spp.M.pneumoniae M.pneumoniae C.pneumoniae C.pneumoniae病毒性病毒性吸入性肺炎吸入性肺炎無病原診斷無病原診斷北美北美1967-951967-95英國胸腔學會英國胸腔學會19871987 1966-951966-9520 30%20 30%20 60%20 60%3 10%3 10%3 5%3 5%3 10%3 10%3 5%3 5%10 20%10 20%2 8%2 8%1 6%1 6%4 6%4 6%2 15%2 15%6 10%6 10%30 60%30 60%60 75%60 75%4 5%4 5%1 5%1 5%RareRareNDNDNANA 2 5%2 5%5 18%5 18%NANA 8 16%8 16%ND ND NA NA65%65%12%12%2%2%1%1%3%3%12%12%4%4%7%7%1%1%3%3%ND ND ND ND肺炎简介医学知识培训9社區性肺炎的病原微生物典型肺炎(細菌)北美1967-95英國常見呼吸道病原之感染季節7 78 89 91010111112121 12 23 34 45 56 6副流感病毒副流感病毒流行性感冒病毒流行性感冒病毒 A&BA&BQ feverQ fever鏈球菌鏈球菌 GASGAS肺炎球菌肺炎球菌 SpSp退伍軍人肺炎桿菌退伍軍人肺炎桿菌 LpLp嗜血桿菌嗜血桿菌 HiHi月份月份黴漿菌黴漿菌 MpMp/披衣菌披衣菌 CpCp腺病毒腺病毒冠狀病毒冠狀病毒原原發發性性肺肺炎炎次次發發性性肺肺炎炎伺機性肺炎伺機性肺炎CMV,PCP,FungusCMV,PCP,Fungus肺炎简介医学知识培训10常見呼吸道病原之感染季節789101112123456副流感肺炎的診斷臨床診斷肺炎的依據n n臨床症狀臨床症狀n n理學檢查理學檢查n nCXR CXR 檢查檢查n n一般檢驗一般檢驗:n n ABG ABGn n CBC/DC CBC/DCn n CRP CRP肺炎的病因診斷？n n培養培養n n細菌染色細菌染色:n n快速抗原快速抗原:n n血清抗體血清抗體:n n分子生物分子生物:PCR:PCR肺炎简介医学知识培训11肺炎的診斷臨床診斷肺炎的依據肺炎的病因診斷？肺炎简介医学知识典型肺炎與非典型肺炎比較表典型肺炎典型肺炎(大葉型肺炎大葉型肺炎)非典型肺炎非典型肺炎(間質浸潤型肺炎間質浸潤型肺炎)常見症狀常見症狀發燒發燒畏寒畏寒咳嗽帶痰咳嗽帶痰胸痛胸痛發燒發燒但較少胸痛及畏寒但較少胸痛及畏寒乾咳乾咳上呼吸道感染症狀上呼吸道感染症狀頭痛頭痛肌肉痛肌肉痛臨床檢驗臨床檢驗白血球上昇白血球上昇通常可在痰中找通常可在痰中找 到致病菌到致病菌胸部胸部光呈大葉光呈大葉 型肺炎型肺炎白血球微幅上昇白血球微幅上昇痰中通常找不到致病菌痰中通常找不到致病菌胸部胸部光呈間質性浸潤光呈間質性浸潤常見病原體常見病原體肺炎雙球菌肺炎雙球菌嗜血桿菌嗜血桿菌克雷氏菌克雷氏菌部分厭氧菌及革部分厭氧菌及革 蘭氏陰性菌蘭氏陰性菌肺黴漿菌肺黴漿菌退伍軍人症退伍軍人症濾過性病毒等濾過性病毒等肺炎简介医学知识培训12典型肺炎與非典型肺炎比較表典型肺炎非典型肺炎常見症狀發燒發燒黴漿菌肺炎(Mp)流行病學(Seattle,1963-75)Seattle US 1963-75Seattle US 1963-75Incidence/1,000/yearIncidence/1,000/yearDefinition:Definition:1.Mp titer 1:321.Mp titer 1:322.Mp titer 4x rise2.Mp titer 4x rise3.Mp isolated3.Mp isolated肺炎简介医学知识培训13黴漿菌肺炎(Mp)流行病學(Seattle,1963-7高雄地區披衣菌肺炎(Cp)血清流行病學年齡年齡%N=N=97972626212131231217117173738484223223787810851085Wang 1993Wang 1993MIF IgGMIF IgG 1:161:1673.4%73.4%肺炎简介医学知识培训14高雄地區披衣菌肺炎(Cp)血清流行病學年齡%N=972621臨床診斷病因診斷培養培養染色染色:Gram,AFSGram,AFS快速抗原快速抗原:血清抗體血清抗體:分子生物分子生物:PCRPCR肺炎的診斷流行病學資訊流行病學資訊臨床症狀臨床症狀理學檢查理學檢查CXRCXR一般檢驗一般檢驗季節性季節性地域性地域性接觸史接觸史傳染源與傳播力傳染源與傳播力潛伏期潛伏期痰痰(採集方式採集方式)咽喉拭子咽喉拭子肋膜液肋膜液血液血液尿液尿液肺炎治療經驗治療經驗治療專一性治療專一性治療檢驗方法檢驗方法適當的檢體與採集適當的檢體與採集輔助治療輔助治療肺炎简介医学知识培训15臨床診斷病因診斷培養肺炎的診斷流行病學資訊臨床症狀CXR季節肺炎的病因診斷方式？顯微鏡顯微鏡抗原偵測抗原偵測抗體抗體-免疫螢光免疫螢光-血清血清微生物培養微生物培養分子生物學分子生物學檢體種類檢體種類適合微生物適合微生物痰痰氣管鏡抽取液氣管鏡抽取液胃液胃液痰痰、氣管抽取液氣管抽取液尿液尿液鼻腔液鼻腔液、痰液痰液血液血液痰痰氣管鏡抽取液氣管鏡抽取液胃液胃液痰痰、氣管抽取液氣管抽取液Sp,Hi,GNB,GPC,Tb,FungusSp,Hi,GNB,GPC,Tb,FungusSp,Hi,GNB,GPC,Tb,fungusSp,Hi,GNB,GPC,Tb,fungusTbTbVirus(Adv,Flu,PIF,RSV,SARS Virus(Adv,Flu,PIF,RSV,SARS LegionellaLegionellaLegionella,virus-specificLegionella,virus-specificMp,Cp,Ct,Legionella,Cb,Flu,Mp,Cp,Ct,Legionella,Cb,Flu,Adv,CXB1-6,Adv,CXB1-6,Mp,Bacteria,Legionella,TbMp,Bacteria,Legionella,TbMp,Bacteria,Legionella,TbMp,Bacteria,Legionella,TbTbTbAny extrinsic pathogensAny extrinsic pathogens肺炎简介医学知识培训16肺炎的病因診斷方式？顯微鏡檢體種類適合微生物痰Sp,Hi,臨床診斷與抗生素的使用OPD antibiotics prescription,data of CDCOPD antibiotics prescription,data of CDC肺炎简介医学知识培训17臨床診斷與抗生素的使用OPD antibiotics pre肺炎的治療單一抗生素治療單一抗生素治療支持性治療支持性治療強化性抗生素治療強化性抗生素治療散彈槍抗生素治療散彈槍抗生素治療預防性抗生素治療預防性抗生素治療?臨床診斷病因診斷肺炎治療經驗治療經驗治療專一性治療專一性治療輔助治療輔助治療單一抗生素治療單一抗生素治療化痰劑化痰劑蒸氣蒸氣物理治療物理治療肺炎治療臨床診斷肺炎简介医学知识培训18肺炎的治療單一抗生素治療支持性治療強化性抗生素治療散彈槍抗生肺炎简介医学知识培训培训ppt课件19臺灣地區主要的呼吸道致病菌抗藥性Hsueh PR.Antimicro Agents Chemother 2000Hsueh PR.Antimicro Agents Chemother 2000肺炎简介医学知识培训20臺灣地區主要的呼吸道致病菌抗藥性Hsueh PR.Anti肺炎治療觀念與方法社區性支氣管肺炎或肺炎社區性支氣管肺炎或肺炎病毒性肺炎病毒性肺炎外因性肺炎外因性肺炎病毒感染併發病毒感染併發細菌性性肺炎細菌性性肺炎院內感染性肺炎院內感染性肺炎低抵抗力肺炎低抵抗力肺炎 症狀治療症狀治療 體液補充體液補充 預防性抗生素預防性抗生素?症狀治療症狀治療 體液補充體液補充 處理併發症處理併發症 選擇治療性抗生素選擇治療性抗生素典型肺炎典型肺炎:S.pneumoniaeS.pneumoniaeH.influenzaeH.influenzaeOthersOthers非典型肺炎非典型肺炎:M.pneumoniaeM.pneumoniaeC.pneumoniaeC.pneumoniaeLegionella spp.Legionella spp.EnvironmentalEnvironmentalS.pneumoniaeS.pneumoniaeH.influenzaeH.influenzaeLegionella spp.Legionella spp.EnterobacteriaeEnterobacteriaeAdenovirusAdenovirusInfluenza Influenza Parainflu.Parainflu.RSVRSVChickenpoxChickenpox%肺炎简介医学知识培训21肺炎治療觀念與方法社區性支氣管肺炎或肺炎病毒性肺炎外因性肺炎常見呼吸道疾病的抗微生物製劑選擇PenicillinPenicillinAmoxicillinAmoxicillinAmoxi/Clavu-Amoxi/Clavu-Ampi-/Sulbact-Ampi-/Sulbact-TetracyclineTetracyclineErythromycinErythromycinAzithromycinAzithromycinCefotaximeCefotaximeCefuroximeCefuroximeTrimeth-/Sulfa-Trimeth-/Sulfa-LevofloxacinLevofloxacin肺炎球菌肺炎球菌嗜血桿菌嗜血桿菌厭氧菌厭氧菌 GNBGNB 黴漿菌黴漿菌 匹衣菌匹衣菌LegionellaLegionella+-+/-+/-+-+-+-+-+-+/-+/-+-+-+-+-+-+-+In vitroIn vitro肺炎简介医学知识培训22常見呼吸道疾病的抗微生物製劑選擇Penicillin肺炎球菌Pneumococcal Disease and Pneumococcal VaccinesEpidemiology and Prevention of Vaccine-Preventable DiseasesRevised December 2004肺炎简介医学知识培训23Pneumococcal Disease and PneumStreptococcus pneumoniaen nGram-positive bacterian n90 known serotypesn nPolysaccharide capsule important virulence factorn nType-specific antibody is protective肺炎简介医学知识培训24Streptococcus pneumoniaeGram-pPneumococcal PneumoniaClinical Featuresn nAbrupt onsetn nFevern nShaking chillsn nProductive coughn nPleuritic chest painn nDyspnea,tachypnea,hypoxia肺炎简介医学知识培训25Pneumococcal PneumoniaClinicaPneumococcal Pneumonian nEstimated 175,000 hospitalized cases per yearn nUp to 36%of adult community-acquired pneumonia and 50%of hospital-acquired pneumonian nCommon bacterial complication of influenza and measlesn nCase-fatality rate 5%-7%,higher in elderly肺炎简介医学知识培训26Pneumococcal PneumoniaEstimatePneumococcal Disease Epidemiologyn nReservoir Human carriersn nTransmission Respiratory Autoinoculationn nTemporal pattern Winterearly springn nCommunicability Unknown Probably as long as organism in respiratory secretions肺炎简介医学知识培训27Pneumococcal Disease EpidemiolInvasive Pneumococcal DiseaseIncidence by Age Group1998*Rate per 100,000 population Source:Active Bacterial Core Surveillance/EIP Network肺炎简介医学知识培训28Invasive Pneumococcal Disease*Invasive Pneumococcal Disease by Age and YearChildren 5 Years,1998-2002*1 yr2 yrs3 yrs4 yrs1 yr*2003 data are preliminary.Source:Active Bacterial Core Surveillance/EIP Network Age group肺炎简介医学知识培训29Invasive Pneumococcal Disease Pneumococcal Polysaccharide Vaccinen nPurified capsular polysaccharide antigen from 23 types of pneumococcusn nAccount for 88%of bacteremic pneumococcal diseasen nCross-react with types causing additional 8%of diseasen nNot effective in children 2 yearsn n60%-70%against invasive diseasen nLess effective in preventing pneumococcal pneumonia肺炎简介医学知识培训30Pneumococcal Polysaccharide VaPneumococcal Conjugate Vaccinen nPneumococcal polysaccharide conjugated to nontoxic diphtheria toxin(7 serotypes)n nVaccine serotypes account for 86%of bacteremia and 83%of meningitis among children 90%effective against invasive diseasen nLess effective against pneumonia and acute otitis media肺炎简介医学知识培训31Pneumococcal Conjugate VaccinePneumococcal Polysaccharide Vaccine Recommendationsn nAdults 65 years of agen nPersons 2 years withn nchronic illnessn nanatomic or functional asplenian nimmunocompromised(disease,chemotherapy,steroids)n nHIV infectionn nenvironments or settings with increased risk肺炎简介医学知识培训32Pneumococcal Polysaccharide VPneumococcal Conjugate Vaccinen nRoutine vaccination of children age 7 months require fewer doses肺炎简介医学知识培训33Pneumococcal Conjugate Vaccine謝謝收看病人常在你身邊正確且適當配戴口罩正確且勤洗手肺炎简介医学知识培训34謝謝收看病人常在你身邊肺炎简介医学知识培训34