《醫(yī)學痢疾》課件

BacillaryDysentery

(shigellosis)Dept.OfInfectiousDiseaseHuangFenBacillaryDysentery

(shigello1DefinitionAcuteinfectiousdiseaseofintestinecausedbydysenterybacilli(genusshigella)

Placeoflesion:sigmoid&rectum

Pathologicalfeature:

diffusefibriousexudativeinflammationDefinitionAcuteinfectiousdis2DefinitionClinicalmanifestation:fever,abdominalpain,diarrhea,tenesmus,stoolmixedwithmucusblood,&pus.evencompaniedwithshock,toxic-encepholopthy.DefinitionClinicalmanifestat3EtiologyCausativeorganism:dysenterybacilli,genusshigella,gram-stainednegative,non-motileshortrod,Groups:4serogroups&47serotypesEtiologyCausativeorganism:4EtiologyS.dysenteriae:

themostsevereS.flexneri:theepidemicgroupandeasilyturntochronicS.boydii:

tropicalandsubonS.sonnei:themostmildEtiologyS.dysenteriae:themo5EtiologyPathogenicity:-virulence

endotoxin-exotoxin-invasiveness(attach-penetrate-multiply)

Resistance:Strong,1-2weekinfruits,vegetableanddirtysoil,heatfor60℃30min

EtiologyPathogenicity:6EpidemiologySourceofinfection:

patientsandcarriersRouteoftransmission:fecal-oralrouteSuceptibilityofpopulation:immunityafterinfectionisshortandunsteady,nocross-immuneEpidemiology7EpidemiologyEpidemicfeatures:season:summer&fallFlexneri,Soneii,dysenteryage:youngerchildren

EpidemiologyEpidemicfeatures8Pathogenesis

numberofbacteriatoxicityinvasivenessattachmentpenetrationmultiplicationimmunity

Pathogenesisnumberofbacteri9

commonBacteriaintestinenormalintestinalflorasIgApreventattachingpenetratemucusmultiplyinepitheliacell&properlaminaendotoxinendogenouspyrogenfeverinflammationvesselcontractionsuperficialmucosalnecrosisandulcerdiarrheamixedwithblood&pus,abdominalpaincommonBacteriaintest10Pathogenesis-toxicstrong-allergytoendotoxindemethyl-adrenalineDICmicro-circulatoryfailureshock,cerebraledemacerebralherniaPathogenesis-toxicstrong-all11

Pathologysiteoflesion:

entirelargebowel-sigmoidcolon&rectumfeature:acute:diffusefibrinousexudativeinflammation,

Pathologysiteoflesion:12Pathologyhyperemia,edema,leukocyteinfiltration,superficialnecrosis,ulcer.chronic:edema,polypoidhyperplasia,toxic:

colon:hyperemia,edema,

micro-capillarywasinvadedPathologyh13ClinicalmanifestationIncubationperiod:1-2day,(hoursto7days)Acutedysenterycommontype

mildtypetoxictypeClinicalmanifestationIncubati14Clinicalmanifestationcommontype:

(typicaltype)acuteonset,shiver,highfeverabdominalpain(tenderness)diarrhea:stoolmixedwithmucus,blood&pustenesmus,1week

Clinicalmanifestationcommont15Clinicalmanifestationmildtype:(atypicaltype)causedbyS.sonneilowfeverornofeverabdominalpainismildstoolmixedwithmucus,withoutblood&pusdiagnosisbyisolationofbacteria3~7dClinicalmanifestationmildtyp16Clinicalmanifestationtoxictype:

age:2to7yrs.abruptonset,highfever,T40oCdysphoria,lethargy,convulsion

repeatedly,coma.circulatory&respiratorycollapsediarrheamildorabsentatbeginning

Clinicalmanifestationtoxicty17Clinicalmanifestationshockform:septicshockbrainform:dysphoria,lethargy,convulsionrepeatedly,coma,brainhernia.respiratoryfailuremixedformClinicalmanifestation18Clinicalmanifestationchronicdysentery:>2monthschronicdelayedtype:chronicobscuretypeacuteattacktypeClinicalmanifestationchronic19Clinicalmanifestationchronicdelayedtype:

long-timeandrepeatedabdominalpain,diarrhea,stoolmixedwithmucus,blood&pus.withfatigue,anemia,malnutrition.

Clinicalmanifestationchronic20Clinicalmanifestationchronicobscuretype:

acutehistoryin1year,nosymptoms,stoolculturepositiveorsigmoidscopyacuteattacktype:

sameascommonacutedysenteryClinicalmanifestationchronic21LaboratoryFindings

Bloodpicture:

WBCcountincrease,(10~20×109/L)neutrophilsincrease

Stoolexamination:grossexamination:

stoolmixedwithmucus,blood&pus.

LaboratoryFindingsBloodpict22LaboratoryFindingsdirectmicroscopicexamination:

WBC,RBC,puscellsbacteriaculture:PCR:DNASigmoidoscopy:chronicpatients

shallowulcerscarpolypLaboratoryFindingsdirectmicr23DifferentialdiagnosisacutedysenteryamebicdysenteryEntamoebahistolyticastool:reddishbrown,likejamflask-shapedulcer,amebictrophozoiteDifferentialdiagnosisacuted24DifferentialdiagnosisenteritiscausedbyE.Coli,salmonella,ussusception:jam-likestools,abdominalmassabsenceoffeverDifferentialdiagnosisenteriti25Differentialdiagnosis

chronicdysenteryrectal&coloniccarcinoma:

nocureforlong-term,dropofweightofbodynon-specificulcercolitis:nocureforlong-term,cultureofstoolisnegative,Differentialdiagnosischronic26Differentialdiagnosissigmoidoscopy:hemorrhage,

ulcer,leadpipe.chronicschistosomiasisJaponicacontactwiththecontaminatedwater

hepatomegalyandsplenomegaly

foundingtheovumofschistosomiasisJaponicaDifferentialdiagnosissig27Differentialdiagnosistoxicdysentery

encephalitisB:highfever,convulsion,coma.<24hcirculatoryfailurestoolexaminationCSFmeningealirritationSpecificIgM

Differentialdiagnosis28TreatmentCommondysenteryToxicdysenterygeneraltreatmentpathogenictreatment:ofloxineAmpicillingivenbyIVTreatmentCommondysentery29Treatmentsymptomatictreatment:controlofhighfever,convulsion:

subhibernationtreatmentofshock:sameasECMtreatmentofcerebraledema:20%mannitolTreatmentsymptomatictreatment30Treatmentchronicdysenterygeneraltherapy:livediet,nurishingavoidoverworkexercise.Treatmentchronicdysentery31etiologictherapy:

sensitiveantibioticsusedinturnorcombineduseaccordingtoresultsofcultureenemaexpectanttreatment.Treatmentetiologictherapy:Tre32Prevention

Controlthesourceofinfection:untilculturenegativeInterruptingtherouteoftransmission:Protectingthesusceptiblepopulation:F2a-secretaryIgAprotect80%-6-12mon

PreventionControlthesource33BacillaryDysentery

(shigellosis)Dept.OfInfectiousDiseaseHuangFenBacillaryDysentery

(shigello34DefinitionAcuteinfectiousdiseaseofintestinecausedbydysenterybacilli(genusshigella)

Placeoflesion:sigmoid&rectum

Pathologicalfeature:

diffusefibriousexudativeinflammationDefinitionAcuteinfectiousdis35DefinitionClinicalmanifestation:fever,abdominalpain,diarrhea,tenesmus,stoolmixedwithmucusblood,&pus.evencompaniedwithshock,toxic-encepholopthy.DefinitionClinicalmanifestat36EtiologyCausativeorganism:dysenterybacilli,genusshigella,gram-stainednegative,non-motileshortrod,Groups:4serogroups&47serotypesEtiologyCausativeorganism:37EtiologyS.dysenteriae:

themostsevereS.flexneri:theepidemicgroupandeasilyturntochronicS.boydii:

tropicalandsubonS.sonnei:themostmildEtiologyS.dysenteriae:themo38EtiologyPathogenicity:-virulence

endotoxin-exotoxin-invasiveness(attach-penetrate-multiply)

Resistance:Strong,1-2weekinfruits,vegetableanddirtysoil,heatfor60℃30min

EtiologyPathogenicity:39EpidemiologySourceofinfection:

patientsandcarriersRouteoftransmission:fecal-oralrouteSuceptibilityofpopulation:immunityafterinfectionisshortandunsteady,nocross-immuneEpidemiology40EpidemiologyEpidemicfeatures:season:summer&fallFlexneri,Soneii,dysenteryage:youngerchildren

EpidemiologyEpidemicfeatures41Pathogenesis

numberofbacteriatoxicityinvasivenessattachmentpenetrationmultiplicationimmunity

Pathogenesisnumberofbacteri42

commonBacteriaintestinenormalintestinalflorasIgApreventattachingpenetratemucusmultiplyinepitheliacell&properlaminaendotoxinendogenouspyrogenfeverinflammationvesselcontractionsuperficialmucosalnecrosisandulcerdiarrheamixedwithblood&pus,abdominalpaincommonBacteriaintest43Pathogenesis-toxicstrong-allergytoendotoxindemethyl-adrenalineDICmicro-circulatoryfailureshock,cerebraledemacerebralherniaPathogenesis-toxicstrong-all44

Pathologysiteoflesion:

entirelargebowel-sigmoidcolon&rectumfeature:acute:diffusefibrinousexudativeinflammation,

Pathologysiteoflesion:45Pathologyhyperemia,edema,leukocyteinfiltration,superficialnecrosis,ulcer.chronic:edema,polypoidhyperplasia,toxic:

colon:hyperemia,edema,

micro-capillarywasinvadedPathologyh46ClinicalmanifestationIncubationperiod:1-2day,(hoursto7days)Acutedysenterycommontype

mildtypetoxictypeClinicalmanifestationIncubati47Clinicalmanifestationcommontype:

(typicaltype)acuteonset,shiver,highfeverabdominalpain(tenderness)diarrhea:stoolmixedwithmucus,blood&pustenesmus,1week

Clinicalmanifestationcommont48Clinicalmanifestationmildtype:(atypicaltype)causedbyS.sonneilowfeverornofeverabdominalpainismildstoolmixedwithmucus,withoutblood&pusdiagnosisbyisolationofbacteria3~7dClinicalmanifestationmildtyp49Clinicalmanifestationtoxictype:

age:2to7yrs.abruptonset,highfever,T40oCdysphoria,lethargy,convulsion

repeatedly,coma.circulatory&respiratorycollapsediarrheamildorabsentatbeginning

Clinicalmanifestationtoxicty50Clinicalmanifestationshockform:septicshockbrainform:dysphoria,lethargy,convulsionrepeatedly,coma,brainhernia.respiratoryfailuremixedformClinicalmanifestation51Clinicalmanifestationchronicdysentery:>2monthschronicdelayedtype:chronicobscuretypeacuteattacktypeClinicalmanifestationchronic52Clinicalmanifestationchronicdelayedtype:

long-timeandrepeatedabdominalpain,diarrhea,stoolmixedwithmucus,blood&pus.withfatigue,anemia,malnutrition.

Clinicalmanifestationchronic53Clinicalmanifestationchronicobscuretype:

acutehistoryin1year,nosymptoms,stoolculturepositiveorsigmoidscopyacuteattacktype:

sameascommonacutedysenteryClinicalmanifestationchronic54LaboratoryFindings

Bloodpicture:

WBCcountincrease,(10~20×109/L)neutrophilsincrease

Stoolexamination:grossexamination:

stoolmixedwithmucus,blood&pus.

LaboratoryFindingsBloodpict55LaboratoryFindingsdirectmicroscopicexamination:

WBC,RBC,puscellsbacteriaculture:PCR:DNASigmoidoscopy:chronicpatients

shallowulcerscarpolypLaboratoryFindingsdirectmicr56DifferentialdiagnosisacutedysenteryamebicdysenteryEntamoebahistolyticastool:reddishbrown,likejamflask-shapedulcer,amebictrophozoiteDifferentialdiagnosisacuted57DifferentialdiagnosisenteritiscausedbyE.Coli,salmonella,ussusception:jam-likestools,abdominalmassabsenceoffeverDifferentialdiagnosisenteriti58Differentialdiagnosis

chronicdysenteryrectal&coloniccarcinoma:

nocureforlong-term,dropofweightofbodynon-specificulcercolitis:nocureforlong-term,cultureofstoolisnegative,Differentialdiagnosischronic59Differentialdiagnosissigmoido