肺炎簡介醫(yī)學知識培訓培訓課件

1、肺炎簡介醫(yī)學知識培訓肺炎簡介醫(yī)學知識培訓World Infection associated mortality 1997/2002(21,000)(282,000)(285,000)(81,000)(745,000)(1,124,000)(2,866,000)(2,001,000)(1,644,000)(3,871,000)WHO The world health report 2002 data(140,000)(275,000)(410,000)(605,000)(960,000)(2,100,000)(2,300,000)(2,455,000)(2,910,000)(3,745,000

2、)20021997肺炎簡介醫(yī)學知識培訓2World Infection associated morCommunity Acquired PneumoniaEpidemiology:4-5 million cases annually500,000 hospitalizations45,000 deathsMortality 2-30%1% for those not requiring hospitalizationfewest cases in 18-24 yr groupprobably highest incidence in 65 yrsmortality disproportion

3、ately high in 65 yrsBartlett. CID 1998;26:811-38.肺炎簡介醫(yī)學知識培訓3Community Acquired PneumoniaEpCommunity Acquired PneumoniaAdeel A. Butt, MD# in 1000sIncidence肺炎簡介醫(yī)學知識培訓4Community Acquired PneumoniaAdCommunity Acquired PneumoniaAdeel A. Butt, MD# in 1000sMortality肺炎簡介醫(yī)學知識培訓5Community Acquired PneumoniaAd

4、Risk Factors for pneumoniaagealcoholismsmokingasthmaimmunosuppressioninstitutionalizationCOPDPVDdementiaCommunity Acquired PneumoniaID Clinics 1998;12:723. Am J Med 1994;96:313肺炎簡介醫(yī)學知識培訓6Risk Factors for pneumoniaComm何謂肺炎？肺炎的診斷依據(jù)？肺炎的定義為何？肺炎是否一定會發(fā)燒？不發(fā)燒是否就一定不會是肺炎？肺炎的治療？肺炎簡介醫(yī)學知識培訓7何謂肺炎？肺炎的診斷依據(jù)？肺炎的定義為何？

5、肺炎是否一定會發(fā)燒呼吸疾病病程與癥狀變化Craig C. Freudenrich, Ph.D. 病毒感染呼吸道細胞被感染的細胞死亡杯狀細胞分泌黏液干擾素與細胞酵素引起發(fā)炎死亡的上皮細胞(病毒)發(fā)炎細胞分泌的黏液鼻咽喉移生的細菌增殖A. Nasal cavityB. PharynxC. LarynxD. TracheaE. AlveoliF. Bronchial treeG. Diaphragm吸引發(fā)炎細胞聚集發(fā)燒、喉痛、噴涕發(fā)燒、流鼻水傳染期痰中耳炎鼻竇炎支氣管炎菌血癥病毒血癥肺炎膿胸肺炎簡介醫(yī)學知識培訓8呼吸疾病病程與癥狀變化Craig C. Freudenric社區(qū)性肺炎的病原微生物典型肺

6、炎(細菌) S. pneumoniae H. influenzae S. aureus GNB Others非典型肺炎 Legionella spp. M. pneumoniae C. pneumoniae病毒性吸入性肺炎無病原診斷北美1967-95英國胸腔學會19871966-9520 30%20 60% 3 10% 3 5% 3 10% 3 5%10 20% 2 8% 1 6% 4 6% 2 15% 6 10%30 60%60 75% 4 5% 1 5%RareNDNA 2 5% 5 18%NA 8 16% ND NA65%12% 2% 1% 3%12% 4% 7% 1% 3% ND ND

7、肺炎簡介醫(yī)學知識培訓9社區(qū)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(jié)789101112123456副流感病毒流行性感冒病毒 A & BQ fever鏈球菌 GAS肺炎球菌 Sp退伍軍人肺炎桿菌 Lp嗜血桿菌 Hi月份黴漿菌 Mp / 披衣菌 Cp腺病毒冠狀病毒原發(fā)性肺炎次發(fā)性肺炎伺機性肺炎CMV, PCP, Fungus肺炎簡介醫(yī)學知識培訓10常見呼吸道病原之感染季節(jié)789101112123456副流感肺炎的診斷臨床診斷肺炎的依據(jù)臨床癥狀理學檢查CXR 檢查一般檢驗: ABG CBC/DC CRP肺炎的病因診斷？培養(yǎng)細菌染色:快速抗原:血清抗體:分子生物:

8、PCR肺炎簡介醫(yī)學知識培訓11肺炎的診斷臨床診斷肺炎的依據(jù)肺炎的病因診斷？肺炎簡介醫(yī)學知識典型肺炎與非典型肺炎比較表典型肺炎(大葉型肺炎)非典型肺炎(間質(zhì)浸潤型肺炎)常見癥狀發(fā)燒畏寒咳嗽帶痰胸痛發(fā)燒但較少胸痛及畏寒乾咳上呼吸道感染癥狀頭痛肌肉痛臨床檢驗白血球上昇通常可在痰中找 到致病菌胸部光呈大葉 型肺炎白血球微幅上昇痰中通常找不到致病菌胸部光呈間質(zhì)性浸潤常見病原體肺炎雙球菌嗜血桿菌克雷氏菌部分厭氧菌及革 蘭氏陰性菌肺黴漿菌退伍軍人癥濾過性病毒等肺炎簡介醫(yī)學知識培訓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癥狀發(fā)燒發(fā)燒黴漿菌肺炎(Mp) 流行病學(Seattle, 1963-75)S

9、eattle US 1963-75Incidence/1,000/yearDefinition:1. Mp titer 1:322. Mp titer 4x rise3. Mp isolated肺炎簡介醫(yī)學知識培訓13黴漿菌肺炎(Mp) 流行病學(Seattle, 1963-7高雄地區(qū)披衣菌肺炎(Cp)血清流行病學年齡%N=9726213121717384223781085Wang 1993MIF IgG1:1673.4%肺炎簡介醫(yī)學知識培訓14高雄地區(qū)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(yǎng)染色: Gram, AFS快速抗原:血清抗體:分子生物:PCR肺炎的診

10、斷流行病學資訊臨床癥狀理學檢查CXR一般檢驗季節(jié)性地域性接觸史傳染源與傳播力潛伏期痰(採集方式)咽喉拭子肋膜液血液尿液肺炎治療經(jīng)驗治療專一性治療檢驗方法適當?shù)臋z體與採集輔助治療肺炎簡介醫(yī)學知識培訓15臨床診斷病因診斷培養(yǎng)肺炎的診斷流行病學資訊臨床癥狀CXR季節(jié)肺炎的病因診斷方式？顯微鏡抗原偵測抗體 -免疫螢光 -血清微生物培養(yǎng)分子生物學檢體種類適合微生物痰氣管鏡抽取液胃液痰、氣管抽取液尿液鼻腔液、痰液血液痰氣管鏡抽取液胃液痰、氣管抽取液Sp, Hi, GNB, GPC, Tb, FungusSp, Hi, GNB, GPC, Tb, fungusTbVirus (Adv, Flu, PIF,

11、RSV, SARS LegionellaLegionella, virus-specificMp, Cp, Ct, Legionella, Cb, Flu, Adv, CXB1-6, Mp, Bacteria, Legionella, TbMp, Bacteria, Legionella, TbTbAny extrinsic pathogens肺炎簡介醫(yī)學知識培訓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 CDC肺炎簡介醫(yī)學知識培訓17臨床診斷與抗生素的使用OPD antibi

12、otics pre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素治療預防性抗生素治療?臨床診斷病因診斷肺炎治療經(jīng)驗治療專一性治療輔助治療單一抗生素治療化痰劑蒸氣物理治療肺炎治療臨床診斷肺炎簡介醫(yī)學知識培訓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簡介醫(yī)學知識培訓培訓課件臺灣地區(qū)主要的呼吸道致病菌抗藥性Hsueh PR. Antimicro Agents Chemother 2000肺炎簡介醫(yī)學知識培訓20臺灣地區(qū)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(qū)性支氣管肺炎或肺炎病毒性肺炎外因性肺炎病毒感染併發(fā)細菌性性肺炎院內(nèi)感

13、染性肺炎低抵抗力肺炎癥狀治療體液補充預防性抗生素?癥狀治療 體液補充處理併發(fā)癥 選擇治療性抗生素典型肺炎:S. pneumoniaeH. influenzaeOthers非典型肺炎:M. pneumoniaeC. pneumoniaeLegionella spp.EnvironmentalS. pneumoniaeH. influenzaeLegionella spp.EnterobacteriaeAdenovirusInfluenza Parainflu.RSVChickenpox%肺炎簡介醫(yī)學知識培訓21肺炎治療觀念與方法社區(qū)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

14、劑選擇PenicillinAmoxicillinAmoxi/Clavu-Ampi-/Sulbact-TetracyclineErythromycinAzithromycinCefotaximeCefuroximeTrimeth-/Sulfa-Levofloxacin肺炎球菌嗜血桿菌厭氧菌GNB黴漿菌匹衣菌Legionella+-+/-+-+-+-+-+-+/-+-+-+-+-+-+-+In vitro肺炎簡介醫(yī)學知識培訓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 VaccinesEpidemiolo

15、gy and Prevention of Vaccine-Preventable DiseasesRevised December 2004肺炎簡介醫(yī)學知識培訓23Pneumococcal Disease and PneumStreptococcus pneumoniaeGram-positive bacteria90 known serotypesPolysaccharide capsule important virulence factorType-specific antibody is protective肺炎簡介醫(yī)學知識培訓24Streptococcus pneumoniaeGra

16、m-pPneumococcal PneumoniaClinical FeaturesAbrupt onsetFeverShaking chillsProductive coughPleuritic chest painDyspnea, tachypnea, hypoxia肺炎簡介醫(yī)學知識培訓25Pneumococcal PneumoniaClinicaPneumococcal PneumoniaEstimated 175,000 hospitalized cases per yearUp to 36% of adult community-acquired pneumonia and 50%

17、of hospital-acquired pneumoniaCommon bacterial complication of influenza and measlesCase-fatality rate 5%-7%, higher in elderly肺炎簡介醫(yī)學知識培訓26Pneumococcal PneumoniaEstimatePneumococcal Disease EpidemiologyReservoir Human carriersTransmission Respiratory AutoinoculationTemporal pattern Winterearly sprin

18、gCommunicability Unknown Probably as long as organism in respiratory secretions肺炎簡介醫(yī)學知識培訓27Pneumococcal Disease EpidemiolInvasive Pneumococcal DiseaseIncidence by Age Group1998*Rate per 100,000 population Source: Active Bacterial Core Surveillance/EIP Network肺炎簡介醫(yī)學知識培訓28Invasive Pneumococcal Disease

19、*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肺炎簡介醫(yī)學知識培訓29Invasive Pneumococcal Disease Pneumococcal Polysaccharide VaccinePurified capsular polysaccharide a

20、ntigen from 23 types of pneumococcusAccount for 88% of bacteremic pneumococcal diseaseCross-react with types causing additional 8% of diseaseNot effective in children 2 years60%-70% against invasive diseaseLess effective in preventing pneumococcal pneumonia肺炎簡介醫(yī)學知識培訓30Pneumococcal Polysaccharide VaPneumococcal Conjugate VaccinePneumococcal polysaccharide conjugated to nontoxic diphtheria toxin (7 serotypes)Vaccine serotypes accoun