湘雅兒科Measles課件

1、湘雅兒科Measles文檔湘雅兒科Measles文檔湘雅兒科Measles文檔概述(overview)麻疹是一種由麻疹病毒引起的急性呼吸道傳染病(Measles is an acute respiratory contagious disease caused by measles virus )2通過閱讀報刊，我們能增長見識，擴大自己的知識面。湘雅兒科Measles文檔湘雅兒科Measles文檔湘雅兒科概述(overview)麻疹是一種由麻疹病毒引起的急性呼吸道傳染病(Measles is an acute respiratory contagious disease caused by m

2、easles virus )2概述(overview)麻疹是一種由麻疹病毒引起的急性呼概述(overview)臨床特征為：發(fā)熱、上呼吸道炎癥、結(jié)合膜炎、Koplik斑與全身性斑丘疹(clinical features: fever,upper respiratory inflammation, conjunctivitis, Kopliks spots and generalized maculopapular rash) 3概述(overview)臨床特征為：發(fā)熱、上呼吸道炎癥、病原(ETIOLOGY)麻疹病毒(measles virus)屬副粘液病毒，無亞型，僅一種抗原型( RNA-con

3、taining virus of the Paramyxovirus family ,only one serotype) 4病原(ETIOLOGY)麻疹病毒(measles viru病原(ETIOLOGY)麻疹病毒(measles virus)麻疹病毒不耐熱，對日光和消毒劑均敏感，但在低溫中能長期保存(Measles virus are rapidly inactivated by heat,light , and all kinds of desinfectant,but can be stored indefinitely at low temperature)。5病原(ETIOLOGY

4、)麻疹病毒(measles viru病原(ETIOLOGY)麻疹病毒(measles virus)存在于患者前驅(qū)期和出疹期的眼結(jié)膜、鼻、咽、氣管等分泌物中(During the prodromal period and eruption period,it is found in sections of conjunctiva, nose , pharynx ,trachea and so on)。6病原(ETIOLOGY)麻疹病毒(measles viru麻疹的發(fā)病機制 鼻、咽 短期繁殖病毒 局部粘膜 血流 遠處器官單核 眼結(jié)膜 （第一次） 巨噬細胞系統(tǒng) 潛伏期大量繁殖 局部癥狀 血流 （第

5、二次） 前驅(qū)期 全身癥狀 7麻疹的發(fā)病機制 7病理(PATHOGEY)全身淋巴組織增生，有多核巨細胞形成 (Hyperplasia of all lymphoid tissue usually occurs,multinucleated giant cells may be found )8病理(PATHOGEY)8病理(PATHOGEY)多核巨細胞(multinucleated giant cells)：多個巨噬細胞融合形成的具有核內(nèi)外包涵體的巨細胞網(wǎng)狀內(nèi)皮巨細胞也稱華-佛細胞（reticuloendothelial giant cells or Warthin-Finkeldey cell

6、s)：存在于全身淋巴組織和肝、脾等臟器中上皮巨細胞（epithelial giant cells）：主要位于皮膚、眼結(jié)合膜、呼吸道和消化道粘膜等處 9病理(PATHOGEY)多核巨細胞(multinucleat病理(PATHOGEY)皮膚、眼結(jié)合膜、鼻咽部、支氣管、腸道粘膜等處可見單核細胞增生與圍繞在毛細血管周圍的多核巨細胞，淋巴樣組織肥大(Prolifieration of mononuclear cells is found in the skin,in the conjunctivae and in the mucous membranes of the nasopharynx, bro

7、nchi, and intestinal tract,multinucleated giant cells occur around the capillaries. Hyperplasia of lymphoid tissue occurs.)10病理(PATHOGEY)皮膚、眼結(jié)合膜、鼻咽部、支氣管、腸道病理(PATHOGEY)頰粘膜下層的微小分泌腺發(fā)炎，其病變內(nèi)有漿液滲出與內(nèi)皮細胞增殖形成Koplik斑 (An inflammatory reaction occurs in the fine secretor of the buccal mucosa, where serous exud

8、ate and proliferation of endothelial cells result in Kopliks spots) 11病理(PATHOGEY)頰粘膜下層的微小分泌腺發(fā)炎，其病變內(nèi)病理(PATHOGEY)麻疹引起的間質(zhì)性肺炎為Hecht巨細胞肺炎 (Interstitial pneumonitis resulting from measles virus takes the form of Hecht giant cell pneumonia)12病理(PATHOGEY)12病理(PATHOGEY)麻疹皮疹的病理改變：真皮毛細血管內(nèi)皮增生、血漿滲出、紅細胞相對增多形成淡紅色

9、斑丘疹(Maculopapular rash consists of proliferation of capillary endothelial cells in skin,serous exudate and relative increase of red cells)疹退后，表皮細胞壞死、角化形成脫屑。皮疹處紅細胞裂解，疹退后形成棕色色素沉著。13病理(PATHOGEY)麻疹皮疹的病理改變：真皮毛細血管內(nèi)皮典型麻疹(Typical measles)潛伏期(Incubation stage)一般為1014天(亦可短至1周)，此期可有輕度體溫上升(It lasts usually 1014

10、 days after contact,maybe as short as 1 week.The temperature may increased slightly)。 臨床表現(xiàn)14典型麻疹(Typical measles)潛伏期(Incub典型麻疹前驅(qū)期 (Prodromal stage)指從發(fā)熱至出疹,一般為3-4天(from fever to rash appearance,usually lasts 3-4 days) 臨床表現(xiàn)15典型麻疹前驅(qū)期 (Prodromal stage)臨床表現(xiàn)1典型麻疹 主要表現(xiàn)：發(fā)熱、上呼吸道炎癥、眼結(jié)合膜炎、Stimson線(fever,upper

11、respiratory inflammation, conjunctivitis ) 麻疹粘膜斑(Kopliks spots)前驅(qū)期 (Prodromal stage)臨床表現(xiàn)16典型麻疹 主要表現(xiàn)：發(fā)熱、上呼吸道炎癥、眼結(jié)合膜炎、SKopliks spots(麻疹粘膜斑) 時間：發(fā)疹前24 48小時出現(xiàn)(24-48 hours before the appearance of the rash)；位置：開始對著下臼齒的頰粘膜上；以后累與整個頰部并蔓延至唇部粘膜(initially opposite the lower molars but may spread the rest of the

12、 buccal and lip mucosa)。臨床表現(xiàn)17Kopliks spots(麻疹粘膜斑) 時間：發(fā)疹前Kopliks spots(麻疹粘膜斑)形態(tài)：直徑約1的灰白色小點，外有紅暈(grayish white dots with 1mm in diameter,usually as small as grains of sand,that reddish areolae)；發(fā)展：1天內(nèi)很快增多，皮疹出現(xiàn)后逐漸消失(They spread rapidly within one day and disappear gradually after the appearance of the

13、 rash)。臨床表現(xiàn)18Kopliks spots(麻疹粘膜斑)形態(tài)：直徑約11919典型麻疹出疹期 (eruption stage) 在發(fā)熱3-5天后出現(xiàn),持續(xù)3-5天 出疹順序:耳后、發(fā)際額、面部頸軀干四肢,達手掌、足底 (initially occurring behind the ears and hairline and spreading down from the forehead and face to neck ,the trunk and the extremities). 臨床表現(xiàn)20典型麻疹出疹期 (eruption stage) 臨床表現(xiàn)2典型麻疹出疹期 (erup

14、tion stage)皮疹性質(zhì):紅色斑丘疹，疹間皮膚正常(red maculupapular rash, there is normal skin among rashes.)臨床表現(xiàn)21典型麻疹出疹期 (eruption stage)臨床表現(xiàn)212222典型麻疹 恢復(fù)期(convalescent period) 皮疹按出疹先后順序消退,伴有糠麩樣脫屑與棕色色素沉著,經(jīng)710天消失(The rash fades downward in the same sequence in which it appeared .As the rash fades , branny desquamation

15、and brownish discoloration occur and then disappear within 7-10 days)臨床表現(xiàn)23典型麻疹 恢復(fù)期(convalescent period 并發(fā)癥(complications)肺炎(pneumonia) 是麻疹常見的并發(fā)癥，多見于出疹期，繼發(fā)細菌或其它病毒感染喉、氣管、支氣管炎(laryngitis,trachitis, bronchitis)心肌炎(myocarditis) 24 并發(fā)癥(complications)肺炎(pneumoni并發(fā)癥(complications)麻疹腦炎與亞急性硬化性全腦炎（measles enc

16、ephalitis and subacute sclerosing panencephalitis 簡稱SSPE)結(jié)核病惡化(tuberculosis exacerbating)營養(yǎng)障礙與維生素A缺乏癥(malnutrition and vitamin A deficiency)25并發(fā)癥(complications)麻疹腦炎與亞急性硬化性全診 斷(DIAGNOSIS)麻疹接觸史(exposure to measles previously)典型臨床表現(xiàn)(typical clinical manifestations)26診 斷(DIAGNOSIS)麻疹接觸史(exposure 診 斷(DIA

17、GNOSIS)前驅(qū)期鼻咽部找多核巨細胞與尿中檢測包涵體細胞(During the prodromal stage, multinucleated giant cells are found in nasopharynx,intrancuclear and intracytoplasmic inclusion bodies cells are found in urine)27診 斷(DIAGNOSIS)前驅(qū)期鼻咽部找多核巨細胞與尿中診 斷(DIAGNOSIS)ELISA法檢測麻疹抗體(Measles virus antibodies become detectable by ELISA whe

18、n the rash ppears;testing of acute and convalescent sera shows the diagnostic seroconversion or fourfold increase in titer)28診 斷(DIAGNOSIS)ELISA法檢測麻疹抗體(Me鑒別診斷病原全身癥狀和其他特征皮疹特點發(fā)熱與皮疹的關(guān)系麻疹(rubeola)麻疹病毒卡他癥狀結(jié)膜炎、發(fā)熱Koplik斑紅色斑丘疹，特別的出疹順序，退疹后有色素沉著幾細小脫屑發(fā)熱34天，出疹時體溫更高風疹(rubella)風疹病毒耳后、頸后、枕后淋巴結(jié)腫大退疹后無色素沉著及脫屑發(fā)熱半天或一天后

19、出疹幼兒急疹exanthema subitum 人皰疹病毒6型一般情況好，耳后、頸后、枕后淋巴結(jié)可腫大頸及軀干部多見，一天出齊，次日消退高熱35天，熱退疹出猩紅熱(scarlet fever)乙型溶血性鏈球菌高熱，中毒癥狀重，咽峽炎、楊梅舌、環(huán)口蒼白圈、扁桃體炎皮膚彌漫充血，密集針尖大小丘疹，1周后全身大片脫皮發(fā)熱12天出疹，出疹時高熱29鑒別診斷病原全身癥狀和其他特征皮疹特點發(fā)熱與皮疹的關(guān)系麻疹(麻疹的流行病學與預(yù)防 流行病學(epidemiology) 傳染源：急性期患者和亞臨床型帶病毒者 預(yù)防(prevention)控制傳染源：隔離患者： 出疹后天，并發(fā)肺炎者10天。 接觸過麻疹的易感者

20、： 隔離檢疫3周30麻疹的流行病學與預(yù)防 流行病學(epidemiolo麻疹的流行病學與預(yù)防流行病學 傳播途徑： 主要是呼吸道飛沫傳播。預(yù)防 切斷傳播途徑：實行“三門”，病人住所、衣物按規(guī)定消毒。31麻疹的流行病學與預(yù)防流行病學預(yù)防31麻疹的流行病學與預(yù)防流行病學預(yù)防保護易感人群：主動免疫(active immunization)，被動免疫(passive immunization)。易感性: 人類對麻疹病毒普遍易感。易感者： 未曾患過麻疹或未接種過麻疹疫苗者。32麻疹的流行病學與預(yù)防流行病學預(yù)防易感性:32治 療(TREATMENT) 無特異抗病毒治療，只有支持治療和對癥治療。(There

21、is no specific antiviral therapy ;treatment is entirely supportive and symptomatic treatment)33治 療(TREATMENT) 無特異抗病毒治療，只有支持治治 療一般治療 給予易消化的富有營養(yǎng)的食物，補充充足水分；保持皮膚、粘膜清潔34治 療一般治療 34治 療一般治療 臥床休息，房內(nèi)保持適當?shù)臏囟群蜐穸?，有畏光癥狀時房內(nèi)光線要柔和 (bed rest , keeping comfortably humidification and warm of the room ;patients with photophobia should be protected from exposure to strong light)。 35治 療一般治療 臥床休息，房內(nèi)保持適當?shù)臏囟群蜐穸?，有畏?療對癥治療 高熱時可用小量退熱