幻灯片 1

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传默滕
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1 Wang Yishu Department of Pathology Basic Medical School

3 1348 年, 令欧洲半数人口丧生的流行性淋巴腺鼠疫黑死病 Ebola hemorrhagic fever (EHF)

流感期间 Camp Funston 的紧急军事医院 1918 年西班牙大流感 1918-1919, 全球大约有 10 亿人感染流感,2500 万到 4000

4 流感期间 Camp Funston 的紧急军事医院 1918 年西班牙大流感 , 全球大约有 10 亿人感染流感,2500 万到 4000 万人死于流感比第一次世界大战死亡人数 (1000 万 ) 还多 1918 年美国人的平均寿命比平常减少了 12 年这次大流感也是第一次世界大战提前结束的原因之一

5 我国传染病发病情况消灭或几近消灭 : 天花麻风脊髓灰质炎得到控制但发生率有上升者 : 结核梅毒新出现的传染病 :

6 SARS 2003

9 2009 年 5 月中国正式将猪流感更名为甲型 H1N1 流感经中国国务院批准, 中国卫生公告, 明确将甲型 H1N1 流感 ( 原称人感染猪流感 ) 纳入传染病防治法规定管理的乙类传染病, 并采取甲类传染病的预防控制措施根据公告, 为有效防止疫情的传入传播和蔓延, 甲型 H1N1 流感还被纳入国境卫生检疫法规定的检疫传染病管理

10 所罗门丢到海里的瓶子, 远远不止一个魔鬼, 正在陆续登陆下一个从潘多拉魔盒里出来的会是?

11 中华人民共和国传染病防治法规定管理的传染病分类甲类 : 鼠疫霍乱乙类 : 病毒性肝炎细菌性和阿米巴性痢疾伤寒和副伤寒艾滋病淋病梅毒脊髓灰质炎麻疹百日咳白喉流行性脑脊髓膜炎猩红热流行性出血热狂犬病钩端螺旋体病布鲁氏菌病炭疽流行性和地方性斑疹伤寒流行性乙型脑炎黑热病疟疾登革热丙类 : 肺结核血吸虫病丝虫病包虫病麻风病流行性感冒流行性腮腺炎风疹新生儿破伤风急性出血性结膜炎除霍乱痢疾伤寒和副伤寒以外的感染性腹泻病

13 Do you Know? What is infection disease? How to prevent infection disease?

14 Introduction of infectious disease 传染病 --- 是由病原微生物侵入人体所引起的具有传染性的一类疾病, 能在人群中引起局部或广泛的流行 s are a group of diseases caused by infectious agents that can be transmitted from one host (person or animal) to another directly or indirectly. s are also known communicable disease, and may spreads rapidly and widely during local or extensive area.

15 Manifestation of infection process 感染过程的表现感染 (infection) 又称传染, 是病原体对人体的一种寄生过程大多数病原体与人体宿主之间是不适应的, 因而引起双方之间的斗争由于适应程度不同, 斗争的后果和表现也不同 Elimination of pathogen 病原体被清除 Covert (subclinical) infection 隐性感染 Overt (clinical) infection 显性感染 Carrier state 病原携带状态 Latent infection 潜伏性感染

16 Spread of pathogenic microorganism 病原微生物的传播 Three basic link of transmission Reservoir ( 传染源 ) Pathways of spread ( 传播途径 ) Susceptible population ( 易感人群 )

17 Routes of entry, dissemination, and release of microbes from the body(pathogenesis of infection disease)

18 Main routes of transmission Digestive tract Respiratory tract Insect-bome transmission Contact transmission Mother-infant

19 Spread of pathogenic microorganism Infectious agents: viruses, bacteria, chlamydiae, rickettsia, mycoplasmas, fungi, spirochete, parasites protective barrier and Invasion of pathogenic microbe: Skin barrier Respiratory tract mucous membrane Digestive tract mucous membrane Urinary tract

20 影响流行过程的综合因素社会因素传染源传播途径易感人群自然因素

21 Mechanisms of Virus-Induced Injury 侵入细胞的特异性进入靶细胞的方式进入细胞后复制潜伏感染和持续感染病毒损害和杀死宿主细胞 Direct Release Prolification

22 Mechanisms of Bacteria-Induced Injury Bacterial adherence Bacterial toxins

23 Immune escape of pathogenic microorganism 病原微生物的免疫逃避 Pathogenecity Invasiveness 侵袭力 Virulence 毒力 Infection dose 病原体的数量 Variability 变异性 Human immunity Nonspecific immunity Specific immunity 微生物的免疫逃避保留不易接近性裂解抗体抵抗补体介导的溶解作用抗原变异和释放引起特异和非特异的免疫抑制

24 Feature of infectious disease 1.Specific pathogenic microorganism 2.Certain infectious way and fashion 3.Pathogenic Microbe localize definite tissue or organize 4.Basic pathologic change is inflammation 5.There is certain phases 6.Getting definite immunity after infection 7.determinate seasonality and local

25 Tuberculosis 结核

结核病的历史从 1815 年滑铁卢战役到 1914 年第一次世界大战爆发前,20-60 岁的成年人中, 肺结核的死亡率是 97% 1882 年 3 月 24 日世界著名的德国科学家科赫氏在柏林宣读发现结核菌, 在 1982 年纪念科赫氏发现结核菌 100 周年时, 世界卫生组织 (WHO) 和国际防痨和肺病联合会 (IUATLD) 共同倡议将 3 月 24

26 结核病的历史从 1815 年滑铁卢战役到 1914 年第一次世界大战爆发前,20-60 岁的成年人中, 肺结核的死亡率是 97% 1882 年 3 月 24 日世界著名的德国科学家科赫氏在柏林宣读发现结核菌, 在 1982 年纪念科赫氏发现结核菌 100 周年时, 世界卫生组织 (WHO) 和国际防痨和肺病联合会 (IUATLD) 共同倡议将 3 月 24 日作为世界防治结核病日, 以提醒公众加深对结核病的认识 1945 年特效药链霉素的发明之前, 此病是不治之症后来又发明了异烟肼 ( 雷米封 ) 和对氨基水杨酸,1957 年这三种药物联合使用, 使结核病得到有效的治疗现代细菌学科学奠基人结核杆菌的发现者罗伯特柯霍曾说过 : 结核病对人类的危害十分严重, 即使那些最可怕的传染病如鼠疫霍乱也应列于其后

29 结核 Tuberculosis Tuberculosis (TB) is a communicable chronic granulomatous disease caused by tubercle bacillus. It usually involves the lungs but may affect any organ or tissue in the body. 结核病是由结核杆菌引起的一种慢性肉芽肿病

30 Tuberculosis Tuberculosis (TB) is a chronic infection disease caused by tubercle bacilli. made distinctive by a necrotizing (caseation) granulomatous tissue (tubercle) response to seeded organisms. It may involve various organs of human body, but the most common type is pulmonary tuberculosis.

31 Etiology and pathogenesis Pathogen:tubercle bacillus M.hominis( 人型 ) and M.bovis( 牛型 )

32 Etiology and pathogenesis 结核分枝杆菌抗酸染色

33 Etiology and pathogenesis 痰培养结核杆菌荧光染色

34 Etiology and pathogenesis Reservoir of infection Patients with active pulmonary TB. Main routes of spread Respiratory tract Digestive tract Wound of skin

35 Pathogenic material of the tubercle bacillus Lipid glycolipid phospholipid cord factor wax D tubercle tubercle caseation + caseation sulfatide Protect tubercle bacillus lipoarabinomannan inhibit AMC, TNF-α IL-10 Complement (opsonin) MC intake Tbc Heat-shock protein autoimmune respone Tuberculin protein caseation capsule for recognition and engulfment of MC

37 Primary infection: Cytoimmunity Cell-mediated immunity delayed hypersensitivity The major cell participated is T cells. This expresses itself in two ways: Appearance of hypersensitivity causing most of the damage. Enhanced resistance to infection and more effective clearing of the bacterium. (IFN-γ) Release TNF

38 18.结核杆菌有时呆在结核内也不急于繁殖出来跟人体打起了持久战

39 Pathogenesis Infection - Immunity hypersensitivity Exudation,necrosis hyperplasia

40 Pathologic Status of Body Bacillus Pathologic Changes Immune Sensitivity NO. Toxicity Features Exudative Sero-fibrinous Change Weak Stronger Large Strong or Serous Proliferative Tubercle Change Stronger Weaker Little Weaker nodule Necrosis Caseous Change Weak Vehement Large Strong necrosis

41 Basic pathological changes chronic granulomatous disease TB is a special type of inflammation degeneration, exudation, proliferation Basic pathological changes of tuberculosis Exudation Proliferation Necrosis Typical change: tuberculous granuloma caseous necrosis

42 Basic pathological changes Exudation is major patholgical change Early, immunity, bacterial number, virulence, hypersensitivity locus:lung, serous membrane, meninges and synovial membrane( 滑膜 ) and so on. pathological character: serous inflammation or serous-fibrinous inflammation

43 Basic pathological changes Exudation is major patholgical change Sequel: Absorption transform to proliferation or necrosis

44 Basic pathological changes Proliferation is major Lesions Bacterial number, virulence Immune response Form tubercle (tuberculous granuloma) Forming process of tubercle Morphology of tubercle

45 Forming process of tubercle

46 Morphology of tubercle

47 tubercle

49 Necrosis is major patholgical change Bacterial number, virulence immunity or hypersensitivity Caseous necrosis Denouement Basic pathological changes

50 yellowish homogenous greasy (dry and cheesy pale yellow)

52 Exudation Proliferation Necrosis

53 Outcome of Basic pathological changes 坏死的结局是什么? 溶解吸收, 分离排出, 机化, 包裹和钙化炎症的结局有哪些? 痊愈 ( 溶解吸收 ), 转为慢性蔓延扩散 ( 局部, 淋巴道, 血道 ) Healing 愈合 Deterioration 恶化

54 Outcome of Basic pathological changes Healing 痊愈 Resolution and absorption Fibrosis, fibrous encapsulation and calcification

55 Resolution and absorption

56 Fibrosis, fibrous encapsulation and calcification

58 Outcome of Basic pathological changes Turn to Deterioration Infiltration progress Dissolution diffusion bronchial or ureter spread cavitation lymphatic spread regional or distant LN hematogenous spread other organs

59 Infiltration progress

60 cavitation

62 Dissolution diffusion

64 Tuberculous cavity Old tuberculose focus New tuberculose focus Dissolution diffusion

66 Pulmonary tuberculosis Primary pulmonary tuberculosis --- childhood tuberculosis Secondary pulmonary tuberculosis --- adult tuberculosis

68 肺结核 -19- 世纪的白色瘟疫

69 大英博物馆收藏的这具木乃伊生前就患有肺结核

70 Primary pulmonary tuberculosis the first infection tubercle bacillus more frequent in children Pathological Features : Formation of primary complex (Ghon complex) Primary focus Tuberculous lymphangeitis Tuberculosis of hilar lymph nodes X- ray : dumbbell likely ( 哑铃状 )

71 Primary focus

72 Primary focus + Tuberculous lymphangeitis

73 Primary focus + Tuberculous lymphangeitis + Tuberculosis of hilar lymph nodes = primary complex

74 primary complex tubercular lymphangitis Tuberculosi s of hilar lymph nodes Primary focus

76 primary complex 哑铃状阴影

77 Primary pulmonary tuberculosis Clinical features and prognosis In most cases patients are asymptomatic tuberculin test OT (+) form bronchus-lymphaden tuberculosis Diffusion Lymphatic diffusion Hematogenous diffusion Bronchial diffusion

79 小结掌握结核病基本病变及其转化规律掌握原发性肺结核病的病变特点及播散方式了解结核病的发病机制

第十四章传染病

第十四章传染病病理学吉林大学白求恩医学院病理学系王悦增所罗门丢到海里的瓶子, 远远不止一个魔鬼, 正在陆续登陆像疟疾结核等主要的疾病在全球许多地区又死灰复燃抗菌素在阻止传染病流行时己越来越无效果 1348 年 : 黑死病在欧洲泛滥 1830 年 : 曼丹印第安人因一次天花流行而灭绝 1918 年 :2000 万人死于一场不可遏止的流行感冒 1982 年 : 医学史上首次出现 AIDS 1997