传染第八版配套课件传染病学总论

单击此处编辑母版标题样式,内科学（传染病）国家重点学科 传染病诊治国家重点实验室,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,56,传染病学总论,Introduction of Lemology,浙江大学 李兰娟,学习意义及重要性,了解传染病的基本理论，基本概念，基本方法,掌握传染性疾病发生与发展规律,认识突发或新发传染病,概 念,感染性疾病,infectious diseases,传染病,communicable diseases,第一节 感染与免疫,一、感染的概念,感染：,病原体与人体的相互作用,感染病：,感染后的临床或亚临床表现,机会性感染,opportunistic infection,条件致病菌,conditional,(,E. coli, Pseudomonas, Fungi,),共生状态,commensalism,二、,感染过程的表现,1,.,清除病原体,elimination of pathogen,2,.,隐性感染,covert infection,3,.,显性感染,overt infection,4,.,病原携带状态,carrier state,5,.,潜伏性感染,latent infection,1.,清除病原体,非特异性防御能力,non-specific,immunity,特异性免疫功能,specific,immunity,主动免疫,active,immunity,被动免疫,passive immunity,2.,隐性感染,病原体仅诱导机体产生特异性免疫应答，不引起或只引起轻微的组织损伤，在临床上不显出任何症状、体征，甚至生化改变，只能通过免疫学检查才能发现,Only make the host producing specific immune response, not having histomorphological damage, no symptoms and signs, no any biochemical changes, only discovered by immunological examinations,病原体,通常,被清除,，但,少数人可转变为病原携带状态,Pathogens can be eradicated or carried,3.,显性感染,病原体侵入人体后，不但诱发免疫应答，而且通过病原体本身或机体的变态反应，导致组织损伤，引起病理改变和临床表现,Make the host producing specific immune response, having pathological changes,显性感染过程结束后，,有些传染病可使,感染者获得较为稳固的免疫力，,另一些传染病,免疫力并不牢固,Immunity can be consolidated or temporary,4.,病原携带状态,病原体,侵入人体后，人体不出现任何的疾病状态，但能携带,并排,出,病原体,，成为传染病流行的,传染源,No,clinical manifestation but microorganism,excreted,分,类,：,按,病原体,：,virus carrier, bacteria carrier,按发生,和持续时间,：,convalescent, healthy or incubatory,carrier,按,携带病原体的,持续时间,：,acute,or chronic,carrier,5.,潜伏性感染,病原体,感染人体后,，机体,免疫功能足以将病原体,局限化但,又不足以将病原体,清除，病原体长期,潜伏起来，待机体免疫功能下降,时引起显性感染,Locates,the pathogen but can not wipes it,out, can,latently for a long,time, can,occurs overt,infection,潜伏性感染与,病原携带,状态,的区别？,What,is the different point between latent infection and carrier state,?,潜伏,感染,显性,感染,病原,携带状态,隐性感染,清除病原体,感染谱频度,三、,感染过程中病原体的作用,侵袭力,invasiveness,毒力,virulence,数量,quantity of pathogens,变异性,variability,病原体的,致病能力,1.,侵袭力,直接侵入人体,invade directly,Leptospira, filariform larva of,Ancylostoma,先黏附于肠或支气管黏膜表面，再侵入组织细胞，如志贺菌、结核分枝杆菌,。致,泻,性,大肠埃希菌能表达受体,（,定植因子,）,和小肠细胞结合,adhere, colonize and produce enterotoxin:,Vibrio cholera,通过,细菌表面成分（如伤寒沙门菌,Vi,抗原）抑制吞噬而促进病原体扩散,promote spread,：,Vi antigen of,Salmonella typhi,2.,毒力,毒素,toxins,外毒素,exotoxin,(,Vibrio,cholera,Clostridium,tetani,Corynebacterium diphtheriae,),内毒素,endotoxin,(,S. typhi, Sh. dysentery,),其他,毒力,因子,穿透能力,filariform,larva of,Ancylostoma,侵袭能力,Sh,. dysenteriae,溶组织能力,Entamoeba histolytica,3.,数量,同一种传染病，入侵病原体的数量与致病能力成正比,The,number of invading pathogen is positive relation with the pathogenicity in the same infectious,disease,不同的传染病，能引起疾病的最低病原体数量可有较大差异,The,least number of the pathogen to induce disease differ greatly in different diseases. For example,S. typhi,is 10000 and,Sh. dysenteriae,is only,10,4.,变异性,变异,因素,variation factors,环境,environmental,、药物,drug,、,遗传,hereditary,变异,类型,various forms,致病力变异,pathogenicity variation,抗原性,变异,antigenic variation,耐药性,变异,drug-resistant variation,四、,感染过程中的免疫应答,保护性免疫应答,：,有利于机体抵抗病原体,非特异性免疫,天然屏障,natural barriers,吞噬作用,phagocytosis,体液因子,humoral factors,特异性免疫,细胞免疫,cell-mediated immunity,体液免疫,humoral immunity,变态反应,：,促进病理改变,特异性,第,二,节,传染病的发病机制,一、传染病的发生与发展,入侵,部位,position of invasion,机体内定位,location in the body,排出途径,route of exclusion,二、组织损伤的发生机制,直接,损伤,direct,damage,毒素作用,action,of the toxin,免疫机制,immunity,mechanism,三、,重要的病理生理变化,发热,pyrexia,急性期改变,蛋白代谢,糖代谢,水电解质代谢,内分泌改变,第三节,传染病的流行过程,一、流行过程的基本条件,传染源,source of infection,患者,measles,隐性感染,者,poliomyelitis,病原,携带者,typhoid,fever, bacillary dysentery,受感染的动物,rabies, plague,leptospirosis, typhus,一、流行过程的基本条件,传播途径,route,of transmission,呼吸道,传播,消化道,传播,接触,传播,contagious transmission,虫媒传播,arthropod-bone transmission,(blood-sucking arthropods: mosquito, lice, flea, sandfly, mite, tick),血液、体液,传播,blood, blood products and body,fluid,其他,：,mother,to,infant (vertical,transmission,),一、流行过程的基本条件,人群,易,感性,susceptibility,of the,crowd,易感者,The,ratio of susceptible persons decide,the,crowd,susceptibility,流行,的,周期性,The,crowd,susceptibility,is relation,to,periodicity of an,epidemic,人工免疫影响,流行的,周期性,The,periodicity,of an,epidemic may be prevented by artificial active immunization,二、影响流行过程的因素,自然因素,natural factors, geography,climate, ecology,疫源地,focus of infection,自然疫源性传染病/人兽共患病,zoonosis,(plague, leptospirosis, human avian influenza),社会因素,social factors, social background, economical condition,cultural level, anti-epidemic measures,第,四,节,传染病的特征,一、四大基本特征,病原体,pathogens,传染性,infectivity,流行病学特征,epidemiologic feature,感染后免疫,postinfection immunity,1.,病原体,有,特异性,specific,应用新技术,可,发现,更多,病原体,Be found with natural science advancements,2.,传染性,是传染病与其他感染性疾病的主要区别,Infectivity is the main distinction between the infectious diseases and other infection,可依据,传染期隔离患者,“Infective period” can be used as a rule to isolate the patient,3.,流行病学特征,流行性,endemic,(sporadic,epidemic, pandemic & epidemic,outbreak),季节性,seasonal distribution in time,地方性,regional distribution,in,space,外来性,exotic,(e.g. cholera and yellow fever),4.,感染后免疫,属,特异性,、,主动,、,保护性,免疫,specific, active, protective, can transfer to newborns through,placenta,持续时间,在不同传染病中有很大,差异,lasting,time varies with the diseases,持续时间,短可出现再感染,、,重复感染,“concomitant immunity” (helminthiasis),二、急性传染病的四期经过,潜伏期,incubation period,前驱期,prodromal period,症状明显期,period of apparent manifestation,恢复期,convalescent period,1.,潜伏期,常态分布,normal distribution, as important evidence of observing, detecting the contact in quarantine work,随病原体的种类、数量、毒力与人体免疫力的强弱而定,related with invading quantity of pathogens, time of the toxin (bacterial food poisoning), wound location (rabies),潜伏期短的传染病，流行时往往呈暴发,2.,前驱期,非特异性,nonspecific,为许多传染病所共有,coexist in many infectious diseases,一般持续,1,3,天,usually persist one to three days, even miss (sudden onset),3.,症状明显期,充分表现特有症状和体征,Special symptoms and signs presented enough, such as rashes, jaundice, heptomegaly, splenomegaly, meningeal irritation signs,为许多,急性,传染病所共有,especially in some acute diseases measles & varicella,某些传染病,可缺如，即,顿挫型,abortive type poliomyelitis, epidemic encephalitis,4.,恢复期,机体免疫力增长至一定程度，体内病理生理过程基本终止,Immunity increases to a certain level,，,appetite and physical strength recovered,可残余病理改变（如伤寒）或生化改变（如病毒性肝炎），病原体尚未能被完全清除（如霍乱、痢疾）,residual pathologic & biochemical change, infectivity may persist (convalescent carrier),可出现再燃,、,复发,recrudescence & relapse, the symptoms repeatedly and fever rise again,三、常见的症状与体征,发热,fever,：,三个阶段、多种热型,皮疹,rash,：,时间、分布、次序、形状,毒血症状,toxemic symptoms,单核-吞噬细胞系统反应,MPS,第,五,节,传染病的,诊断,传染病的诊断依据,临床资料,clinical data,详尽的病史、细致的体检,流行病学资料,epidemiological,data,发病年龄、职业、季节、地区，集体发病史,预防接种史、过去史、家族史,实验室检查,laboratory data,常规检查、病原学检查、免疫学检查等,直接检出,microscope or macroscopy,病原学检查,分离培养,cultured or isolated,分子生物学检测,分子杂交,hybridization assay,聚合酶链反应,polymerase chain reaction,特异性抗体检测,特异性抗原检测,免疫标记技术,细胞免疫功能检查,免疫学检测,第,六,节,传染病的,治疗,传染病的治疗方法,一般及支持疗法,general and supporting,病原,/,特效疗法,anti-pathogenic,对症疗法,symptomatic,中医中药,Chinese traditional,第,七,节,传染病的,预防,传染病的预防方法,控制传染源,management of the sources of infection,病人：,早发现、早诊断、早隔离、及时上报,接触者：,检疫、密切观察、药物预防/预防接种,病原携带者：,治疗、教育、调整岗位、随访观察,切断传播途径,interruption of the route of,transmission,主要,针对：,消化道,传染病、虫媒传染病、寄生虫病,方法：,消毒,（预防性和疫源性）、杀虫,、卫生,措施,保护易感人群,protection of susceptible,population,特异性主动免疫：,疫苗、菌苗、类毒素,特异性被动免疫：,抗毒素、丙球、高滴度免球,丙 类,11,种,法定传染病,乙 类,26,种,甲 类,2,种,中华人民共和国,传染病防治法,我国法定传染病,甲 类,2,种,鼠疫、霍乱,我国法定传染病,其中：,SARS,、人感染高致病性禽流感、肺炭疽和脊髓灰质炎,按照甲类传染病管理,乙 类,26,种,我国法定传染病,传染性非典型肺炎,、艾滋病、病毒性肝炎、,脊髓灰质炎,、,人感染高致病性禽流感,、麻疹、流行性出血热、狂犬病、流行性乙型脑炎、登革热、,炭疽,、细菌性和阿米巴性痢疾、肺结核、伤寒和副伤寒、流行性脑脊髓膜炎、百日咳、白喉、新生儿破伤风、猩红热、布氏杆菌病、淋病、梅毒、钩端螺旋体病、血吸虫病、疟疾 、甲型,H,1,N,1,流感,(09,年,),丙 类,11,种,流行性感冒、流行性腮腺炎、风疹、,急性出血性结膜炎、麻风病、流行性和,地方性斑疹伤寒、黑热病、包虫病、丝虫,病、其他感染性腹泻病、手足口病（,08,年）,我国法定传染病,儿童计划免疫是预防关键,年龄,疫苗种类,出生,24,小时内,乙肝疫苗第,1,针,出生,24,48,小时内,卡介苗,1,个月,乙肝疫苗第,2,针,2,个月,3,个月,脊髓灰质炎三型混合疫苗,百白破疫苗,4,个月,脊髓灰质炎三型混合疫苗,百白破疫苗,5,个月,脊髓灰质炎三型混合疫苗,百白破疫苗,6,个月,乙肝疫苗第,3,针,8,个月,麻疹疫苗,1,周岁,A,群流脑疫苗,2,周岁,百白破疫苗,A,群流脑疫苗,4,周岁,脊髓灰质炎三型混合疫苗,A,群流脑疫苗,7,周岁,卡介苗,麻疹疫苗,百白破疫苗,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Thanks!,谢谢！,