大五上師兄總結(jié)-2014傳染期末復(fù)習(xí)

第一章principlesofinfectious 第二章viral 第三章Influenza,Avianinfluenza第四章EpidemicHaemorrhagicFever/Hemorrhagicfeverwithrenal 第五章JapaneseB 第六章 第七章ScrubTyphus恙蟲病，Cysticercosis囊尾幼蟲 第八章 第九章TyphoidandParatyphoid傷 第十章 第十一章Meningococcal 第十二章Septic 第十三章Leptospirosis鉤端螺旋體 第十四章 第十五章Amebiasis，Shigellosis志賀菌/Bacillary principlesofinfectious theperiodbetweentheinvasionofthetissuesbypathogenstheappearanceofclinicalfeatures theperiodfromonsetofdiseasestoapparentclinical3、=sequela后遺 bodyfunctionabnormalafterrecoveringofdiseases4、-recrudescence---Thereappearanceofchill,feverandplasmodiuminbloodaftermalariahasbeentreatedtonoapparentsymptomsforseveraldays.Itoccursmainlyin1-4weeksafterrecoveryduetosuppressionoftheimmunesystembyanyofthefourkindsofplasmodiumanditisrepeatable。5、-relapse---Thesymptomsofmalariareappear,suchaschill,fever,sweatetc.afteranti-malariatreatmentwhichisduetothereactivationofbradysporozoiteintheliver.Itisonlycausedbytertianmalariaandovalemalariamainlyin3-6monthsafterrecovery。6CommensalismPathogensliveinthehostbutdon’tinduce7、-機(jī)會染opportunisticinfection---Pathogenswithinthehostcaninducepathologicchangesifhostimmunityissuppressedbysomefactors.8、-重復(fù)Repeatedinfection---malaria,schistosomiasis，在被某種病原體的基礎(chǔ)上再次被同一種病原體。9、-混合（同時(shí)）Mixedinfection---同時(shí)被兩種或兩種以上的病原體。10、-Superinfection---Infectionbyonepathogenatthebaisisofanotherpathogen，HBVoverlapHEV。11、Secondaryinfection繼發(fā)染---HBVfollowingbacilli，在中，發(fā)生于12、Primaryinfection染---Primarypathogenscausediseaseasaresultoftheirpresenceoractivitywithinthenormal,healthyhost,andtheirintrinsicvirulenceis,inpart,anecessaryconsequenceoftheirneedtoreproduceandspread.measles,chickenbox。、性疾病municabledisease---Causedby:、chlamydia、richettsia、prion、paasi（helmnthprotozoaorinectommuiabiliywhichdifferentiatesinfectionsfromnon-infectiousdiseasesTransmissionofpathogenicorganismstootherpeople,directlyorindirectly,mayleadtoanepidemic.14、-covertinfection隱染/亞臨床---指病原體侵入后，僅誘導(dǎo)機(jī)體產(chǎn)生特異性15、=latentinfection潛伏---Afterinfection,pathogensremainlatentinsidethebody.Developclinicalmanifestationswhenthehostimmunityhasbeenimpaired.Pathogensusuallywillnotbeexcretedbythehostduringperiodoflatency.Herpessimplex16、-overt顯染apparent/臨床---指病原體侵入后，不僅誘導(dǎo)機(jī)體產(chǎn)生特異性 18、=Infection---Thecourseofstrugglebetweenpathogensandhumanoranimalbodies19、=sourceofinfection傳染源---指病原體已在體內(nèi)生長、繁殖并能將其排出體外的人和動(dòng)20Elimination---pathogenswereexcludedoutbyhostnonspecificorspecificimmunitySuchas:HepatitisA。21、=epidemiologicalprocess---是傳染病在人群中發(fā)生、發(fā)展和轉(zhuǎn)歸的過程，包括傳染源、22、-后免疫Post-infectionimmunity---免疫功能正常的經(jīng)顯性或隱染某種病原23、-verticaltransmissionmothertobaby28、=Sustainedfever稽留熱---Differenceofbodytemperaturelessthan1degreecentigradewithin24hours,over39℃.e.g.Secondweekoftyphoid。29、=Remittentfever弛張熱---Changeofbodytemperaturemorethan1within24hours,thebaselinehigherthannormal.e.g.30=Intermittentfever間歇熱---Fluctuationbetweennormaltemperatureandhighfeverwithin24hours.e.g.Malaria.31、=Relapsingfever回歸熱---Feverlasting5~7dayswithrelapseafterseveral Relapsingfever,brucellosis.32、-Irregularfever不規(guī)則熱---Curveofbodytemperatureisirregular.e.g.Brucellosis,33、-Toxemicsymptoms---symptomsbesidefevercausedbymetaboliteofpathogen,includingbacteriotoxin.Generalpresentations:malaise;headache;anorexia、paininmuscles,jointsandbones、disturbanceinconsciousness、Meningealirritation、septicshock、Liverandkidneyfailure,etc.34、Enanthem粘膜疹---Rashonmucousmembranemucosae.gKoplikspotsin35、Exanthem皮疹---Rashonskinsurface,e.gchickenpox36Maculopapularrash斑丘疹---e.gMaculaandpapuleMaculopapuleinmeaslesrosespotsintyphoidfever.-神經(jīng)性食物---毒素性食物--1、-propertiesofcommunicabledisease①Presenceofallinfectiousdiseasesarecausedbytheirspecificpathogen.②Infectivity:theinfectiousdiseasescanbetransmissibletootherpeaplethroughsomepathways.③Epidemiologicalfeatures:suchasage,sex,season;importedorendemic;sporadic,epidemic,pandemicoroutbreaks.④Post-infectionimmunity:aftertheinfection,thebodyscanformthespecificimmunitytothepathgenthatcausestheinfectiousdisease。chronic;typical,atypical(mild,severe).②Subclinicalinfection:nosymptoms.poliomyelitis.③Carriers:chronic:typhoid.④Infectedanimals:(naturalsource)rabies,（2）Routesoftransmission：①Air,droplets,dusts:e.g.measles,diphtheria②Water,food,flies(fecal-oralinfection):e.g.typhoid,cholera③Fingers,utensils(contactinfection):e.g.shigellosis,influenza.④Arthropods:A.Biologic:intermediatehosts,e.g.mosquitoesinmalaria,chiggersinscrubB.Mechanicalpassivetransfere.gfliesinamebiasis⑤Bloodbodyliquidtransmission，SuchasHBV,HIV⑥Verticaltransmission:mothertobaby⑦Horizontaltransmission:others（3）3、傳染病的臨床特點(diǎn)①incubationperiod潛伏期：theperiodbetweentheinvasionoftissuesbypathogensandtheappearanceofclinicalfeatures；②prodromalperiod前驅(qū)期：fromonsetofdiseasestoapparentclinicalfeatures；③Symptomaticperiod癥狀明顯期：Apparentofclinicalmanifestations.convalescentperiodlightenanddisappearclinicalmanifestations,Lab.Normal⑤sequela后遺癥期：bodyfunctionabnormalafterrecoveringof4、-傳染病的診斷標(biāo)準(zhǔn)----（1）Clinicalmanifestations：①M(fèi)odeofonset②Typeoffever③panyingsymptoms:headachemyalgiaarthalgiaetc.SignsskinrashKoplikspoteschar,hemorrhae（2）pidemiologialOccupation,livingenvironmentandlifestyle.Historyofvaccination.④Historyoftransfusionproducts（3Laboratorystooletc.②Detectionandisolationofpathogens：ADirectexamination、B.Culture、CAnimalinoculation、D.SpecificImmunologicaldetection、E.Molecularbiologicassay，③otherexamination：Xray、Isotope、Ultrasound、CT、MRI。5、-傳染病的治療原則----Principlesoftherapy（1）Aimoftreatment:①foralleviationofsymptomsandsigns②forisolationofpatients③Comprehensivetreatmentincludesdrugtherapy,nursingcareandisolation④Payattentiontobothspecificandsymptomatictreatments（2傳6Therapeuticmethods----①Generalandsupportivetreatment.②Etiologic(specific)treatment.Symptomatictreatment.Rehabilitationtherapyforsequelae.⑤TraditionalChinesemedicineandacupuncture.7-傳染病的預(yù)防---（1）Measuresagainstthesourceofinfection：①Reportofcases：KindA:,cholera,smallpox,SARS.<6hs，KindB:AIDS,hepatitis,etc.<12hs，KindC:influenza,mumps,etc.<48hs.②Isolationofpatients③ ofcontacts④Identificationandanimals（2InterruptGeneralhygienicmeasures:Cleandrinkingwatersupply,Foodhygiene,Correctsewagedisposal.②Disinfectionanderadicationofinsectvectors.③Interventionofparasitelifecycles（3）Protectionofthesusceptible (immunoglobulins)，②Protectionfromenvironmentalfactors:e.g.mosquitoesbites。8特殊病癥Pathoghomonicsigns----Measles: Scrubtyphus:eschar，Leptospirosis: calfmuscle，Typhoid:rosespots，Cysticercosis:subcutaneousnodules，Hepatoencephalopathy:flaptremor，Shigellosis:mucus-pus-bloodystool，Amebicdysentery:strawberryjam-likestool，Rabies:hydrophobia。9、病原體破壞組織的機(jī)制----①Directinvasion,theenzymessecretedbypathogencancausecytolysis,tissuenecrosisandinflammation.②Theactionsoftoxinsandcytokines,thetoxinsandcytokinescouldresultinginsepticshock,disseminatedintravascularcoagulation,DICetc.③Immunopathogenesis,includeimmunosuppression,T-celldestruction,immunecomplexes.Theimmunopathogenesishappenedmorethantheothertwomechanism,butinmostofthecase,wecouldseemorethantwomechanism.10過程中病原體及免疫反應(yīng)扮演的角色therolesofpathogensandimmuneresponseininfectionprocess----①Invasiveness:adhesion,penetrationability.Shigella②Virulence:toxins,enzymes,andhistolyticability.E.histolytica③Infectiondose:minimaldosethatcancauseaninfectionStyphi④Variability:changeinstructureofthepathogentoevadefromhostimmunity.Influenza。-流行性腮腺炎的檢查特點(diǎn)---：56=一老伯，發(fā)熱，疲勞，頭痛，腰痛，腹痛來就診。一周，少尿4天。查體：體溫37.228次每分。結(jié)膜充血，咽喉有瘀點(diǎn)，胸壁有紅斑，無肝脾腫大，四肢無壓痛，無淋腫大，血常規(guī)WBC增高，血紅蛋白正常，血小板低，肝功異常，BUN上升，CR下降.4周前有野外接觸嚙齒動(dòng)物史viral1HBe轉(zhuǎn)換HBeseroconversion---HBeAgsuggestsHBVreplicationandhighinfectivity.TheproductionofHBeAbwiththeHBeAgdisappearingisseroconversion.AfterHBeAbispositive,thereplicationofHBVisstaticandtheinfectivityisratherlow。2coninfection---Twokindsofpathogensinfecttheindividualatthesametime.ForexampleHBVandHDVinfectthepatienttogether.3、Hepaticencephalopathy---centralneuraldysfunctioncausedbyseveredamageoftheliverfunction.Itiscausedbyconsciousdisturbance,flaptremoraswellascoma.2、-重癥肝炎severehepatitis的臨床表現(xiàn)----①constitutionalandgastrointestinalsymptomsprogressrapidly;severefatigue,liversize essmallerandhepaticodor；②jaundiceprogressesrapidlywithserumbilirubinmorethan171umol/L③A.bleeding:prolongedprothrombintime,PTA<40%;B.neurologicalsymptomsduetocerebraledemaandhighintracranialpressure;C.complicatedinfection:SBP(spontaneousbacterialperitonitis);D.hepaticencephalopathy;E.hepatic-renalsyndrome;F.toxicabdominaldistentionandascites；④foursubtypes:A.acuteliverfailure(fulminanthepatitis,degreeIIHEPwithin2w)B.subacute(15d-26wdegreeIIHEP);C.acute–on-chronicliverfailure;D.chronicliverfailure(basedoncirrhosis)。3、-重癥肝炎的診斷（1）ClinicalData：①rapidlyprogressivejaundice,serumμmol/L②theliver essmallerprogressivelywithhepaticodor(肝臭)③bleedingtendency,asterixisinearlystagehepaticcoma,grossdisorientation, puting,dysphoria(煩躁不安),somnolence(嗜睡)hepaticrenalsyndrome:oliguria,anuria,BUNincreasing（24、-重癥肝炎的治療/慢性重型乙型肝炎chronicseverehepatitisB的治療原 andsupportivetreatment:stayinbedwithintensivecare,avoidgreasyfood,sufficientcarbohydrate,electrolytebalanceandacid-baseequilibrium,sufficientalbumininordertoavoidtoomuchenteralprotein(avoidHEP),maintainpositivenitrogenbalance,bloodvolumeandcolloidpressure,nohepatotoxicityorrenaltoxicitydrugs；②promotionofhepaticcellregeneration:HGF(肝細(xì)胞生長因子)orG-I(胰高血糖素-胰島素)therapy；③preventionofcomplications并發(fā)癥:hepaticencephalopathy;upperalimentarytracthemorrhage;secondaryinfection;hepaticrenalsyndrome(avoidrenaltoxicitydrugsandlowbloodvolume)；④antiviraltherapy:HBVDNA>=105copies/mLusenucleosides；⑤artificialliversupportivesystem；⑥liver5、-性肝炎的鑒別診斷----①Jaundicecausedbyotheretiologicalagents:hemolyticobstructivejaundice；②Hepatitiscausedbyotheretiologicalagents:infective,chemical,autoimmune,inheritedmetabolicdisorder(Wilson’s)。6、-典型急性黃疸型肝炎acuteicterichepatitis的臨床表現(xiàn)----Theacuteicterichepatitiscontainsthreephrases:①prodromalphrase:Asudden(HAV,HEVorinsidiousonset(HBV,HCV,HDV)lasting5-7daysB.constitutionalsymptoms:malaise,fatigue,mildfeversometime,darkurine,;Cgastrointestinalsymptoms:anorexia,vomitingpoorappetite，abdominaldistension,nausea,acheinrightupperabdomen,lossofdesiretosmokeordrink;D.LFTchange:serumALTlevelrisesdramatically.②Jaundicephrase:A.Jaundiceappearsandculminatesoftenin2wafteronset;B.pruritus,tenderliverpalpable;C.othersymptomssubsideafterjaundice;D.serumandurinebilirubinevaluatesandserumALTevaluatesfor2-6w.③convalescentphraseA.symptomsandjaundicegradualresolution;B.Liverreturnstonormalsize;C.serumALTandbilirubindecrease;D.Thisprocessneeds1-2m.

evidecs

（1）Hemolyticjaundice:①predispositionfactors:drugsinfections，②clinicalmanifestations:anemia,flankpain,fever,hemoglobinuria,increasingreticulocyte③mildjaundice,indirectbilirubinpredominantly④disappearsoonafteradrenocorticalhormonetreatment（2）Obstructivejaundice(肝外):①reasons:cystitis,cholelithiasis,pancreaticheadcarcinoma,duodenalampullarycarcinoma,HCC,amoebicabscess②primarysymptomsandsigns③mildliverdamage,distensionofintrahepaticandextrahepaticbileducts④directbilirubinincreasing。9、-的預(yù)防①controlthesourceofinfection:AcutepatientsshouldbeisolateduntilHBVcannotbedetected.Theinfectivityofchronicpatientsshouldbeevaluatedandthepatientsshouldreceiveanti-HBVtherapyoncemeetthestandard.Patientswithcurrentinfectionisnotallowedjobslikefoodprocessingandbabysitting.②cutthetransmissionroute:Sterilizinginserviceindustry，Good syringe，Controlbloodandboldproduct，Preventmother-to-infanttransmission；③protectthesusceptiblecrowd：Activeimmunization:vaccineforHBVforpre-exposureprevention，Passiveimmunization:HBIGforpost-exposureprevention。10、-途徑TrytodescribethetransmissionofHBVHumanbeingsareinfectedbrokenskinormucusbyHBVthroughbloodorhumorpollutedbyHBV.①mother-to-infant:A.intra-uterusinfectionthroughplacenta;B.perinatalperiod(圍產(chǎn)期)isthemostdominantwayofHBVinfection.Infantisinfectedthroughthebrokenskinormucuscontactingdirectlywiththeinfectedmaternalblood,vaginasecretionsandamnioticfluid.;C.post-deliveryinfectionbytheclosedcontact.②boodbloodproductsandbodyfluidbloodtransfusion,injectionoperation,transplantation,dialysis③others:infectionthroughbrokenmucusofGIorrespiratorytractremainsunclarified.、-、cannotexcludeHBVinfection②HBsAb:aprotectiveantibody,meansimmunitytoHBVIfbotharepositive,thismeansthepatientintheconvalescentphraseorthemutationofSgene；①HBeAg:parallelwithHBVDNA,meanstheactivereplicationofHBVandahigh②HBeAb:AfterHBeseroconversion,HBeAgisnegativewhileHBeAbturnstopositive.ThismeansthereplicationofHBVisstaticandtheinfectivityisratherlow.①HBcAg:positivemeansanactivereplicationofHBVwithinfectivity;usuallycannotbedetected，②HBcAb:hightiterofIgMisusefulforthediagnosisofacutehepatitisorchronichepatitisactivestage，hightiterofIgGmeanscurrentinfection,usuallycoexistswithHBsAg，lowtiterofIgGmeanspastinfection,usuallycoexistswithHBsAb，IfonlyHBcAb-IgGispositive,thismeanspastinfectionorlowlevelofinfectionespeciallyinhightitercases.12、HBVDNA定量檢測的臨床意義theclinicalsignificanceoftativedetectionofHBVDNA（1）Itissignificantinestimatingdegreeofviralreplication,infectiousnessandcurativeeffectofanti-viraldrugs（2Diagnosis:①HBVDNAisthemostdirectbasisfortheexistenceofHBV.②HBVDNAisthesymbolofHBVreplication.③HBVDNAisthesymbolofinfectiousness.④Complementarydiagnosisforserologicalmarkers:a.HBeAg(-)oranti-HBe(+),Hepatitisb(mutationinpreCareab.HBeAg(-)Hepatitisb(mutationinSareac.Lowinfectionforexample,b（3reatment:factorindecidingwhethertouseanti-viraldrugs.②Usedforpredictionofcurativeeffect:Generally,curativeeffectofanti-viraldrugsisbetterinpatientswithlowtiterofHBVDNA.UsedforassessmentofcurativeeffectHBVDNAisthemostsensitiveindexinassessingcurativeeffectofanti-viraldrugsatpresent。13、乙型肝炎的臨床表現(xiàn)----(1)acutehepatitis；(2)chronichepatitis；(3)severehepatitis；(4)cholestatichepatitis；(5)hepatitiscirrhosis。14、急性無黃疸型肝炎的臨床表現(xiàn)(1)theacuteanicterichepatitisisfarmorecommontheictericone.(2)mildclinicalmanifestation,similartosymptomsoficterichepatitisexceptjaundice.(3)recoversoon,thecourseofdiseaseisabout3m.15慢性肝炎的臨床表現(xiàn)----①SeenonlyinhepatitisB,CandD, infectionover6months②Severityvariable,3subtypes:mild,typicaland ③monmanifestations:malaise,fatigue,poorappetite, fortinrightupperabdomen④Jaundiceseeninsome⑤Enlargementofliverand/orspleen⑥Spidernaevi,hepaticpaincaseswithlongdiseasehistory⑦AbnormalLFTs:aminotranferase,bilirubin,A/G⑧Extrahepaticdiseases:16、的抗治療（1）InterferoncaninhibitthereplicationofHBVDNA.HBVreplicationperiod;activestageofhepatitiswithnormallevelbilirubin;lowrationallevelHBVDNAinbloodserum.②Prescription:5millionunitspertime.Intramuscularadministrationeverytwoday.③Course:halfayeartooneyear（2）nucleotideoguescanalsoinhibitthereplicationofHBVDNA,lamivudineiswidelyused.①Indication:strictlymastertheindicationoflamivudine,withtheguidancefromexpertdoctors.Checkliverfunctionanddovirologicalexaminationevery1or2months②Prescription500mgpertime.③CourseatleastoneyearTraditionalChinesemedicine:RadixSophoraeSubprostratae.Injection,4ml/d,acourseof3-6months.(大概)28歲男,半月前勞累飲酒后出現(xiàn)疲乏、厭油……尿色加深，服中成藥后無好轉(zhuǎn)，黃疸4*5cm瘀斑。心肺無異常。肝脾未觸及，腹部膨隆，移動(dòng)性濁音(+)，壓痛及反跳痛(+)。：ALT13__._?,ALB34._?,AFP107.2?,PTA33%,HBsAg、HBeAg(+),HBV第三章Influenza,Avianinfluenza1、Influenza---Acuterespiratoryillnesscausedbyinfluenzaes.Typicalsymptoms-feverchills,myalgia,headache,sorethroat,cough.Seriouscasesinyoungchildrenandelderly.2、Reye'ssyndrome---Influenzacausesfattyliverwithminimalinflammation,andsevereencephalopathy(withswellingofthebrain).Thelivermay eslightlyenlargedandfirm,andjaundiceisnotusuallypresent.days（2ypicalofsystemicsymptoms：Headache,fever,chills,myalgia,ormalaise.respiratorytractsigns,particularlycoughandsorethroat.②Ocularsignsandsymptomsincludepainonmotionoftheeyes,photophobia,andburningoftheeye.③examinationofthepharynx:severesorethroat.injectionofthemucousmembranesandpostnasaldcervicallymphadenopathy.④Chestexamination:largelynegative.rhonchi,wheezes,andscatteredrales.lastfor4-7days.（3）Primaryinfluenza onia:persistentfever,dyspnea,andeventualcyanosis.Sputumproductionisgenerallyscanty.Cardiacfailure,liverfailureandrenalfailure.Physicalfindings:noconsolidationsigns.Mildforminfluenza（5）OtherformsStomachflu、Encephalitistransversemyelitis2、流感的治療----①Generalmanagement:bedrestandintakeenoughwater,supplementoxygenandfluidtotheseverelyillpatients.②Managementsforthesymptoms:drugsforlowerbodytemperature,painmanagement,coughsuppressandeliminatethesputum.③Antiviraltreatments:giveAmantadinetheatthebeginning.④Antibacterialtreatmentstothepatientswhohavesecondaryinfection.3、高致病性的治療highpathogenichumanavianinfluenza----Atthebasicofquarantination、symptomstreatment、anti-treatment,weshoulddo:①enhancenutrientsupplement；②enhanceblood-gassurveillanceandrespirationsupplement;③preventandtreatsecdonarybacteriainfection；④preventandtreatothercompliancewithmesuressuchasusingcorticosteroidforimprovingtoxicemiaandrespirationdystressinshortcourse。第四章流行性熱EpidemicHaemorrhagicFever/Hemorrhagicfeverwithrenalsyndromes1、=Petechia瘀點(diǎn)---isasmall(1-2mm)redorpurplespotonthebody,causedbyaminorhemorrhage(brokencapillarybloodvessels).SeeninHemorrhagicfeverwithrenalsyndromes、denguefever。2HFRSHemorrhagicfeverwithrenalsyndromes，isaninfectiousdiseaseswithnaturalCausedbyHantann,Transmittedbyrat,Characterizedbyfever,hemorrhage,proteinuria,shockandacuterenalfailure。3、Hypervolemiasyndrome---InoliguricstageofHemorrhagicfever,retentionofwaterandsodiumcausesincreaseofbloodvolume,presentingsuperficialvenousengorgement,strongpulseandincreaseofpulsepressureandheartrate.4、ARDS(Acuterespiratorydistresssyndrome)---Itisseverehypoxemiaduetopulmonaryinterstitialedema,presentingprogressivedyspnea,cyanosis,arterialoxygenpartialpressurebelow60mmHg.Itiscommonlyseeninshockstageandoliguricstage.1-Trytodescribethepathophysiologyofhemorrhagefeverwithrenalfunctionfailure病生shock：①Primaryshockoccurinhypertensionphase: andimmuneresponsesmallbloodvesseldamage---permeabilityofvessel↑---plasmaexudation---bloodvolume↓---bloodSecondaryshock:Occurindiureticphasebecauseofefficientbloodvolumedecrease.（2）Hemorrhage：Capillarydamage;Pla etdecreaseanddysfunction;DIC;increasedHeparin-likeanuria（3Acutekidneydamageofsmallvesselandrenaltubule③Renalinterstitialhemorrhageandedema④Renaltissuenecrosis⑤Activationofrenin,angiotensinII⑥Renaltubulewasblockedbyproteinsandcasts。lasts3-7days,Featureofpyrexia:Sustainedfeverorremittentfever②Intoxicationsymptoms:headache,lumbago,orbitalpain;hiccup,vomiting,abdominalpainanddiarrhea③Capillarydamagesigns:hyperemia,Hemorrhage,Exudativeedema④Kidneydamagesigns:proteinuria,sometimeswithcasts,bloodcellsandmembrane-shapedsustance（2）Hypotensie(shock)phase低血壓休克期：Occurduringdefeverscencein4to5daysofdiseasescourse,lasts1to3days.Mainsigns:pain.（3OliguricOccurorsoonafterhypotensivephase,in5to8daysofdiseasescourse.lasts2-5days.afewofcases,lastfor10days：Oliguriaoranuria，Uremia，Metabolicacidosisandimbalanceoffluidsandelectrolyte（4）Diretcphase多尿期：Urine3000ml/24h，Occurin9to14daysofdiseasescourse,lastfor1dayorseveralmonthsThreephase(accordingtourinevolumeandazotemiasigns)：①Transitionphase②Earlystageofdiureticphase③Latestageofdiureticphase；3、-流行性熱的診斷----（1）Epidemiologicdata：epidemicplace,season,historyofcontactingratsorexcretionandsecretionsofrats（2）Clinicalfeatures：①Pyrexia,“threeaches”,intoxicatingsymptoms②“Threeflush,conjunctivacongestionandedema,hemorrhage③Oliguria,renalregionpainonpercussion④Fivephaseintypicalcase（3Laboratorydata：①proteinuria，membrane-shapedsubstanceinurine.③specific antigenIgMAb，orIgGAbfourtimesincrease，ViralRNAbyRT-PCR.4-腎綜熱發(fā)熱期的治療Treatmentinfebrilephase----Principleoftreatment①Anti-therapy：Ribavirin；②Reduceexudationof symptoms：PhysicalmeasuresForhyperpyrexia，Corticosteroidsforhyperpyrexiaandheavyintoxicatingsymptoms，Anti-vomiting；④PreventingfromDIC：Reducethebloodviscosity，anti-coagulationtherapy。 Principleoftreatment:①Balanceintra-Correctimbalanceoffluidelectrolytes,acid-base，Reducingproteindegradationandcontrolofazotemia，②Diuretictherapy：20%Mannitolsolution，③Catharsistherapyforpreventingfromhypervolemia：inducingdiarrheatotakeoutfluidsbyintestinal，④Dialysistherapyforserious6、腎綜熱總原則----（1）①Diagnosis,restandtreatmentinearly②Treatmentinnearhospital（2）①Supportivetreatment②Anti-viraltherapy③Symptomatictreatment。7、腎綜熱休克期的治療----Principleoftreatment:①Supplementbloodvolume：early,severetoxemia,Reducepermeationofsmallvessel，Improvingmicrocirculationoftissue.8流行性熱多尿期的治療（1）Principleoftreatmentinthetransitionandearlystagediureticphaseissamewitholiguricphase.（2）Inthelatestageofdiureticphase：①Keebalanceoffluidandelectrolytes.②Preventingandtreatmentsecondaryinfection:9、Modesoftransmission----①Air-bornetransmission(most),②Food-bornetransmission,③Infectionviacontact,④Verticaltransmission,⑤Arthropod-borne(Needtobeconfirmed)。Epidemicfeatures----①Districtlocalization:mainlyinAsia,thenEuropeandAfrica,America②Seasonality:NovembertonextJanuaryandMaytoJulytransmittedbyApodemusagrarius)MarchtoMay(transmittedbyhouserats)。10、流行性熱的鑒別診斷----①Infebrilephase：withcommoncold,influenza,Septicemia.②InHypotensivephasewithotherinfectionshock③Pyrexia,intracraniahemorrhageandcerebraledemawithmeningococcalmeningitis④OliguriaandrenalfailurewithacutenephritisPyrexiaandhemorrhagewithLeptospirosisMarkedhemorrhagewith:thrombocytopenicpurpura,gastrointestinalbleedingcausedbygastriculcer.-典型的腎病綜合征熱（少尿期1、診斷及診斷依據(jù)（10分2、該病例的治療原則（15分腎綜熱JapaneseB1、JapaneseBencephalitis---isadiseasecausedbythemosquito-borneJapanese.Domesticpigsandwildbirdsarereservoirsofthe;transmissiontohumansmaycauseseverecentralnervesystemsymptoms.-Vomiting,Abdominalpain,Drowsy,Neckrigidity,Covulsions,Seizures（）AcuteEncephaliticStage:4-10d.①Highfever:forabout7~10days，②Changesinconsciousness:dullness,tremor,stupor,ataxia,focalordiffuseparalysis,coma，.Convulsions:localizedorgeneralized,Tremorsinfingers,tongue,eyelidsandeyes，④.Respiratoryfailure：highintracranialpressure,edemaofthebrain,herniaofthebrain（with瞳孔和生命體征變化⑤.SignsandsymptomsinCNS:within10d.superficialreflexes↓.Deepreflexes↑andthen↓Meningealirritationsign:Stiffneck,positiveKernig’ssignandpathologicalreflexes.⑥Circulationfailure:rare（3）Theweeks（4Sequela: （1）Materialsofepidemiology：intheepidemicarea,summerormosthappenedinchildrenlessthan10years（2）clinicalmanifestationhighfever,headache,vomiting,disturbanceofconsciousness,convulsions,pathologicalreflexesandmeningealirritation（3laboatoryIgMinserumorCSF，②Definitivediagnosis：isolation:Blood,CSFsample,brain。3----ToxicshigellosisandotherToxicEncephalopathy,CerebralMalaria,Meningococcalmeningitis,Tuberculousmeningitis,FebrileConvulsion,Rey’sSyndrome,4-乙腦的治療AGeneraltreatment.BSymptomatictreatment:①highfeverPhysicalice,alcohol,coolsaline&Artificialhibernation②Seizureandconvulsions:Sedation,Corticosteroidsmaybeused③Respiratoryfailure:Oxygensupply,artificialrespiration④raisedintracranialpressure:Mannitoliv.drip1mg/Kgevery6~8hrs.⑤Treatmentforconvalescenceand5、-如何預(yù)防乙腦----（1）Vector(Mosquito)control：①Eliminatemosquitobreedingareas:Chemicallarvicides,Biolarvicides,EnvironmentalmanagementAdultandlarvalcontrol:Anti-larvaltreatment（2）accination（3）alprotectivemeasures：①Avoidprimemosquitohours:fromdusktodawn②Indoorsprayandfogging:UseofInsecticide。6、-Labinvestigation病例分析----①Peripheralblood ysis:WBC(10~20)X109/L,neutrophilic＞80%②CSFysis:clear,tensionelevated,WBC(50~500)X106/LNeutrophilsmaypredominateinearlyCSFsamplesbutalymphocyticpleocytosisistypicalProteinglucoseandchloridenormallevel→③Serologicaltests:IgMantibody(earlystage)IgGantibody:highspecificity,peakat5-6weeks.④isolation。7、乙腦預(yù)后----mild&moderate:goodrecovery.Severe&fulminate:20%mortality(centralrespiratoryfailure)。8clinicalcoursecanbedividedintofourphases:①TheProdromalStage：Usuallylastsfortheinitial1to3days.Theviremiaphase.②TheAcuteencephaliticStage：Beginsbythethirdtotenthday.Thesymptomsinclude:Highfever;Changesinconsciousness;Convulsions;Respiratoryfailure;Meningealirritationsign；③TheConvalescenceStage：Usuallylastsforatleasttwoweeks.Defervescenceoffeverandneurologicimprovement④TheSequelaStage：30-50%ofsurvivorsmayhaveneuropsychiatric該病例的診斷及依據(jù)（8分該病例的治療措施（8分脾未捫及，KernigS征陽性，Babinski陽性，白細(xì)胞升高，N86%。（乙腦1、-SaddleFever馬鞍熱---inthesomecaseoftypicaldenguefever,thefeverwillremittonormalafter3-5days,butreplaceagainafter1day。2、=enhancingantibody促進(jìn)性抗體---It’sthespecificantibodyproducedbytheorganismafterbeinginfectedwiththedengue,whichhasweakneutralizationbutstrongenhancement,itcanenhancesthecombinationbetween andtheFcreceptorlocatedonthesurfaceof4、dengueFever---Anacute,self-limited,febriledisease.Dengue aremaintainedinacyclehumans、Aedesaegypti，prima