<4D F736F F F696E74202D20B4ABC8BEB2A1BACDBCC4C9FAB3E6B2A12E707074>

Size: px

Start display at page:

Download "<4D F736F F F696E74202D20B4ABC8BEB2A1BACDBCC4C9FAB3E6B2A12E707074>"

孥窦
7 years ago
Views:

1 传染病和寄生虫病浙江大学病理学与病理生理学系陈俭

2 概念传染病是由病原微生物通过一定的传播途径进入易感人群的个体所引起的一组疾病必须同时具备传染源, 传播途径和易感人群三个基本环节

3 伤寒 (typhoid fever) 是由伤寒杆菌引起的急性传染病病变特征是全身单核巨噬细胞系统细胞的增生, 以回肠末端淋巴组织的病变最为突出临床表现 : 持续发热神经系统中毒症状和消化道症状相对缓脉脾肿大皮肤玫瑰疹及嗜中性粒细胞和嗜酸性粒细胞减少等

4 病因与发病机制伤寒杆菌, 粪口传播细菌的繁殖和内毒素释放败血症和毒血症肠粘膜坏死脱落及溃疡形成

5 病理变化及临床病理联系以巨噬细胞增生为特征的急性增生性炎伤寒肉芽肿具有病理诊断价值增生活跃时巨噬细胞浆内吞噬有伤寒杆菌红细胞和细胞碎片, 这种巨噬细胞称伤寒细胞伤寒细胞常聚集成团, 形成小结节称伤寒肉芽肿

6 伤寒肉芽肿

8 基本病理变化肠道病变髓样肿胀期坏死期溃疡期愈合期其他病变器官肿大, 玫瑰疹, 凝固性坏死 ( 蜡样变性 )

11 伤寒并发症肠出血肠穿孔支气管肺炎

12 细菌性痢疾 (bacillary dysentery) 简称菌痢, 是由痢疾杆菌所引起一种假膜性肠炎病变部位 : 多局限于结肠病变特点 : 大量纤维素渗出形成假膜, 假膜脱落伴有不规则浅表溃疡形成临床表现 : 腹痛腹泻里急后重粘液脓血便

13 病因与发病机制痢疾杆菌, 粪口传播内毒素外毒素

14 病理变化与临床病理联系主要发生于大肠, 尤以乙状结肠和直肠为重急性细菌性痢疾特征性的假膜 : 粘膜浅表坏死, 在渗出物中有大量纤维素, 后者与坏死组织炎症细胞和红细胞及细菌一起形成假膜假膜脱落, 形成地图状溃疡里急后重

15 This is an example of pseudomembranous enterocolitis. The mucosal surface of the colon seen here is hyperemic and is partially covered by a yellow-green exudate.

17 This is another example of pseudomembranous inflammation, this time in the ileum. A greenish-yellow exudate covers most of the mucosal surface.

18 Shigella enterocolitis. Segment of colon showing pale, granular, inflamed mucosa with patches of coagulated exudate.

19 Pseudomembranous colitis from C. difficile infection. A, Gross photograph showing plaques of yellow fibrin and inflammatory debris adherent to a reddened colonic mucosa. B, Low-power micrograph showing superficial erosion of the mucosa and an adherent pseudomembrane of fibrin, mucus, and inflammatory debris.

20 Microscopically, the pseudomembrane is seen to be composed of inflammatory cells, necrotic epithelium, and mucus in which the overgrowth of microorganisms takes place. The underlying mucosa shows congested vessels, but is still intact.

21 At higher magnification, the overlying pseudomembrane at the left has numerous inflammatory cells, mainly neutrophils.

22 慢性细菌性痢疾菌痢病程超过二个月以上新旧病灶同时存在疤痕形成肠腔狭窄腹痛腹胀腹泻等肠道症状

23 中毒性细菌性痢疾起病急骤严重的全身中毒症状肠道病变和症状轻微出现中毒性休克或呼吸衰竭发生与内毒素血症有关

24 性传播性疾病性传播性疾病 (sexually transmitted diseases, STD) 是指通过性接触而传播的一类疾病淋病尖锐湿疣梅毒 AIDS

25 淋病 (gonorrhea) 由淋球菌引起的急性化脓性炎, 是最常见的 STD 成人几乎全部通过性交而传染, 儿童可通过接触患者用过的衣物等传染淋球菌主要侵犯泌尿生殖系统, 对柱状上皮和移行上皮有特别的亲和力

26 Acute epididymitis caused by gonococcal infection. The epididymis is replaced by an abscess. A normal testis is seen on the right.

27 尖锐湿疣 (condyloma acuminatum) 是由 HPV( 主要是 HPV 6 型和 11 型 ) 引起的 STD 好发于潮湿温暖的粘膜和皮肤交界的部位主要通过性接触传播, 但也可以通过非性接触的间接感染而致病

28 病理变化呈疣状颗粒, 呈菜花状生长表皮浅层凹空细胞出现有助诊断应用免疫组织化学方法可检测 HPV 抗原, 用原位杂交 PCR 和原位 PCR 技术可检测 HPV DNA(15-10), 帮助诊断

29 尖锐湿疣的组织学特征 : 左上为凹空细胞, 左下为 HPV 外壳蛋白免疫组织化学染色阳性

30 HPV DNA 鉴定 : 上图为 HE 染色, 下图为 HPV DNA(6/11 型 ) 原位杂交阳性

31 梅毒 (syphilis) 是由梅毒螺旋体引起的传染病病因及传播途径 : 梅毒螺旋体梅毒病人为唯一的传染源

32 梅毒的基本病变闭塞性动脉内膜炎和小血管周围炎树胶样肿 : 又称梅毒瘤 (syphiloma) 镜下结构颇似结核结节, 中央为凝固性坏死, 形态类似干酪样坏死可发生于任何器官, 最常见于皮肤粘膜肝骨和睾丸

33 后天性梅毒分一二三期第一期梅毒梅毒螺旋体侵入人体后 3 周左右, 形成下疳第二期梅毒下疳发生后 7~8 周第三期梅毒常发生于感染后 4~5 年先天性梅毒

34 Treponema pallidum (dark-field microscopy) showing several spirochetes in scrapings from the base of a chancre.

35 Protean manifestations of syphilis.

36 Syphilitic chancre in the scrotum

37 Secondary syphilis in the dermis with perivascular lymphoplasmacytic infiltrate and endothelial proliferation.

38 Trichrome stain of liver shows liver gumma (scar), stained blue, which is caused by tertiary syphilis (also known as hepar lobatum). Compare with nodules of alcoholic cirrhosis

39 获得性免疫缺陷综合征 (AIDS) 是由人类免疫缺陷病毒 (human immunodificiency virus, HIV) 感染所引起以全身性严重免疫缺陷传播迅速发病缓慢病死率极高

40 病因和发病机制 AIDS 由 HIV 感染所引起 CD4+T 细胞功能受损及大量破坏, 致使细胞免疫缺陷, 从而引起机会感染和恶性肿瘤的发生 HIV 还可侵袭单核巨噬细胞系统的细胞和其他细胞

41 The structural components, including the key antigenic components, of human immunodeficiency virus are diagrammed here.

42 Schematic illustration of an HIV-1 virion. The viral particle is covered by a lipid bilayer that is derived from the host cell.

43 Pathogenesis of HIV-1 infection. Initially, HIV- 1 infects T cells and macrophages directly or is carried to these cells by Langerhans cells. Viral replication in the regional lymph nodes leads to viremia and widespread seeding of lymphoid tissue. The viremia is controlled by the host immune response (not shown), and the patient then enters a phase of clinical latency. During this phase, viral replication in both T cells and macrophages continues unabated, but there is some immune containment of virus (not illustrated). There continues a gradual erosion of CD4+ cells by productive infection (or other mechanisms, not shown). Ultimately, CD4+ cell numbers decline, and the patient develops clinical symptoms of full-blown AIDS. Macrophages are also parasitized by the virus early; they are not lysed by HIV-1, and they may transport the virus to tissues, particularly the brain.

44 Mechanism of HIV entry into host cells. Interactions with CD4 and CCR5 coreceptor are illustrated.

45 The life cycle of HIV. The steps from viral entry to production of infectious virions are illustrated.

46 Mechanisms of CD4 cell loss in HIV infection.

47 Proposed role of HIV, KSHV (HHV8), and cytokines in the pathogenesis of Kaposi sarcoma. Cytokines are produced by the mesenchymal cells infected by KSHV, or by HIV-infected CD4+ cells. B cells may also be infected by KSHV; their role in the disease is unclear.

48 AIDS 的传播途径性传播通过输血或血制品传播通过注射针头或医用器械等传播围产期传播其他

49 HIV 感染的机理

50 AIDS 的临床分期 HIV 感染期 ARC(AIDS-related complex) AIDS

51 HIV 感染的典型过程

52 AIDS 的临床分期

53 Typical course of HIV infection. A, During the early period after primary infection. B, Immune response to HIV infection.

54 AIDS 的病理变化免疫学损害的形态学表现感染, 常常是混合性机会感染肿瘤, 最常见为 Kaposi 肉瘤和非霍奇金恶性淋巴瘤

55 AIDS 免疫学损害的形态学表现淋巴结病理组织学和免疫组织化学改变淋巴结病变 Warthin-Finkeldey 型多核巨细胞胸腺消化道和脾脏淋巴组织萎缩不同程度脾脏肿大

56 HIV infection showing the formation of giant cells in the brain.

57 Toxoplasma gondii infection can also occur in the heart. Here a pseudocyst appears in myocardium.

58 感染 AIDS 病人对各种病原体非常敏感在一个病人体内可有多种感染混合存在少见的混合性机会感染

59 肿瘤非霍奇金恶性淋巴瘤 (NHL) 中枢神经系统原发性 ; 组织学类型以未分化型 ( 小无裂细胞性 ) 为多见 ; 绝大多数 ( 约 95%) 是 B 细胞来源 ; 淋巴结外 NHL 发生率高, 病人年轻, 预后差 ; 一部分病人 ( 约 1/3) 的 NHL 可能与 EB 病毒有关 Kaposi 肉瘤 1/3 的 AIDS 病人有 Kaposi 肉瘤有毛细血管样结构 ( 血管裂隙 ) 和梭形细胞构成

60 Malignant lymphoma is typically extranodal in AIDS. Seen here in small intestine are two mass lesions on the mucosal surface.

61 Visceral involvement with Kaposi's sarcoma in AIDS is common. Here are multiple reddish irregular masses in the liver.

63 AIDS 时中枢神经系统改变 AIDS 脑病机会感染机会性肿瘤目前认为 HIV 通过巨噬细胞进入中枢神经系统引起病变

64 Toxoplasma gondii infection is most often manifested in the central nervous system. Multiple abscesses that are ring-enhancing with CT scans can be seen.

65 HIV encephalitis. Note the microglial nodule and multinucleated giant cells.

66 A, Toxoplasma abscesses in the putamen and thalamus. B, Free tachyzoites demonstrated by immunostaining. C, Toxoplasma pseudocyst with bradyzoites highlighted by immunostaining.

67 血吸虫病 (schistosomiasis) 血吸虫寄生人体引起的地方性疾病血吸虫感染有固定的中间宿主 - 钉螺经血循环到达体内

68 Schistosome life cycle.

69 病变及发病机制尾蚴所致的损害童虫所致的损害成虫所致的损害虫卵所致的损害

70 虫卵结节急性虫卵结节表面有嗜酸性物质, 周围是无结构坏死区和大量嗜酸性粒细胞聚集慢性虫卵结节假结核结节循环抗原引起的免疫损害

71 图注 : 肝内晚期急性虫卵结节汇管区内多个结节 ( ), 放射状排列的上皮样细胞结节中可见淋巴细胞浸润, 纤维组织增生, 其内有虫卵

72 图注 : 肝小叶汇管区结缔组织增生, 形成结节中心可见多核巨细胞, 周围大量炎细胞浸润可见钙化虫卵 ( )

73 Schistosoma mansoni granuloma with a miracidiumcontaining egg (center) and numerous, adjacent, scattered eosinophils.

74 Pipe-stem fibrosis of the liver due to chronic Schistosoma japonicum infection.

75 Schistosoma haematobium infection of the bladder with numerous calcified eggs and extensive scarring.

76 主要脏器的病变及其后果肠道 : 累及直肠乙状结肠和降结肠, 虫卵沉积, 腹痛腹泻脓血便, 息肉增生肝脏 : 血吸虫性肝硬变脾脏 : 脾脏肿大, 脾功能亢进肺 : 咳嗽等脑肾 :

77 阿米巴病 (amoebiasis) 溶组织内阿米巴感染所引起病变部位主要在结肠, 也可在肝肺等地流行性肠阿米巴病肠外阿米巴病

78 肠阿米巴病的病因和发病机制粪口传播又称阿米巴痢疾滋养体致病机理尚不明确

79 Amebiasis from infection with Entamoeba histolytica is diagnosed here on trichrome stain of a stool specimen.

80 病变及分期病变部位主要位于盲肠, 升结肠, 其次为乙状结肠和直肠以组织溶解为主的坏死性炎症急性期病变 : 烧瓶状溃疡, 具有诊断意义慢性期病变增生为主, 形成阿米巴肿

82 Entamoeba histolytica in colon. High-power view of the organisms. Note some of the organisms ingesting red blood cells.

83 肠外阿米巴病阿米巴肝脓肿肠阿米巴病的重要并发症单个巨大脓肿, 破絮状内壁阿米巴肺脓肿阿米巴脑脓肿

84 Necrotizing amoebic meningoencephalitis involving the cerebellum (organism highlighted by arrow).

附件2

附件2 吉林大学教师教案 (2009 ~2010 学年第二学期 ) 课程名称 : 病理学年级 :2008 级五年制教研室 : 病理教研室任课教师 : 王悦增吉林大学教务处制教案课程名称 : 病理学授课教师王悦增所在单位白求恩医学院病理学系课程类型理论课