结核病总论英文

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1、我国结核病的疫情状况 WHO 93年宣布“全球结核病紧急状态”，98年又重申遏制结核病的行动刻不容缓。全球现有结核病人2000万，其中95在发展中国家，每年还会新发生800-1000万肺结核病，其中75的病人年龄在1550岁。如不控制，今后10年还将有9000万人发病。中国是全球22个结核病高负担国家之一，结核病人数位居世界第二位，仅次于印度.据调查全国三分之一的人口已感染了结核菌；受感染人数超过4亿,受结核感染人群中有10的人发生结核病1tuberculosis factor of tuberculosis incidence rising：HIV spread.TB strain occu

2、r drug resistance.fluid population increasing.Management TB patient not perfect、prevention and cure not efficiency.Poverty、population increasing.2etiology Mycobacterium、Acid fastness、G+、aerobe。Growth torpidity,culture need 4-6 weeks.Typing:human type、bovine type、Bird type、mouse type、main human type。

3、way of infection：respiration tract、digestive track、skin or placenta.3Epidemiology 1 infection sources：open pulmonary tuberculosis 2 route of transmission:by respiration way or digestion tract.3 susceptible population4Epidemiology The factors lead Children ill with TB Contact TB amounts and toxicity.

4、power of resistance.hereditary factor.5pathogenesybacterial number、toxicity、immunization condition Cell-mediated immune reaction:macrophage swallow TBantigen presentation Th and macrophageIL12CD+4TH1-IF-to promote mononuclear cell;to gather、activation、proliferation and differentiationto produce alex

5、in and oxidase、digestive enzymeto kill TB6pathogenesy IF-reinforcement CD+8、NK cells activity to phagocytosis TB.meanwhile to lead histoclasia delayed allergy:T cell media，macrophage to be effector cell，to kill reinfection TB and cause cheesy necrosis or hole formation After Infection TB:primary dis

6、ease（5%），Secondary disease（5%）,not to fall ill all live(90%)7 diagnose Objective to discover focal。Definite disease character、size whether or not deliver bacterium。8diagnose 1 history TB toxic symptom to contact TB patient BCG vaccination acute infection:measles，pertussis Supersensitivity erythema n

7、odosum、exanthematous conjunctivitis。9diagnose 2：OT test agent：1/2000 or 1/10000 PPD dose：0.1ML（OT 5U）（or 1U）。position：left forearm palmaris below 1/3 Infuse intracutaneous form 6-10mm hillock。4872hr observation reaction。10diagnosis reaction 5mm(-)5mm(+)10-19mm(+)20mm(+)Super reaction:induration、vesi

8、c、local ulceration(+)。11diagnosis significance positive reaction After BCG vaccination Older children positive reaction indicate to be ever infected with TB before。Infant never BCG vaccination indicate new infection recent。Strong positive reaction indicate there is activeness TB.。from（-）to（+）、from 1

9、0mm,or increase 6mm by activeness TB.。12diagnosis negative reaction never infection TB first Infect TB during 4-8 weeks false negative reaction，immune function to be pressed down。Wrong with test or PPD ineffective13diagnosis BCG Vaccination and natural infection positive reaction conditionResult inf

10、ectionBCG vaccinationextent（1015mm)(59mm)to changeSlowly(710d)Faster 23ddurationto last lifetimeto last 34 yearsformDeep red hardRed soft14diagnosis3：laboratory examination（1）find TB specimen：sputum、gastric juice、C.S.F、serous cavity liquid.method：smear、fluorescent staining、BACTEC system：culture for

11、2 weeks，test mycobacteria metabolism production，to distinguish TB and atypical.mycobacteria.L tubercle bacterium：mutation TB，form、construction、acid-fast staining different from common TB。Easy passing placenta，therapeutic inefficacy。15diagnosis（2）immunology and molecular biology test ELISA（酶联免疫吸附试验）E

12、LIEP（酶联免疫电泳技术）DNA探针 PCR（聚合酶链式反应）线条DNA探针杂交试验 ESR(血沉)。16diagnosis4：chest X-RAY To definite focus of infection position、extent、category、activity condition。To evaluate and follow up therapeutic efficacy。CT more clear to find the focus、extent and spread condition。5：bronchofiberscopy check：to definite End

13、otracheal membrane TB and tuberculosis of trachebronchial lymph nodes。6：lymph node puncture smear or lymphaden biopsy to diagnosis。17tuberculotherapy general treatment nutrition、to take a rest。avoiding to contact infection disease。Primarily TB treatment in out-patient clinic and regularity return vi

14、sit。Report epidemic situation。18tuberculotherapy Treatmen target To kill Bacillus tuberculosis in focus to prevent disseminate。therapeutic principle early treatment Reasonable dosage Combine medicine Regularity take drug to insist on whole course Segmenting treatment.19tuberculotherapy Anti-tubercul

15、osis drugs Whole germicide：in acid and alkali，exterior and interior of cell can kill germ。(INH RFP)Half germicide：in acid or alkali environment kill cell interior or exterior TB，SM/PZA bacteriostatic：EMB（ethambutol)ETH(ethionamide)20tuberculotherapy new antituberculosis to Anti drug resistant Rifama

16、te(contain INH 150mg RFP300mg)Rifater(INH,RFP PZA)old drug derivant：Rifapentine New chemicals：Dipasic，to delay resistant INH drug standard treatment：refer to asymptomatic primarily pulmonary tuberculosis usage：INH+RFPEMB course of treatment 912 month.21化疗方案 Two stage therapy refer to：activeness prim

17、arily pulmonary TB:acute miliary tuberculosis;brain TB;intensification therapy：（purpose）Combination 34 germicide drugs Longer 34mo、shorter 2mo。continue treatment stage Combination two drugs to keep therapeutic effect for 1218mo.(longer rang)or 4mo.(Short-rang)。22化疗方案 short-range therapy WHO importan

18、t strategy to cure tuberculosis mechanism of action is fast kill organism inner cell or out cell。To sputum bacterium(-)，recovery fast，recurrence less。2HRZ/4HR、2SHRZ/4HR、2EHRZ/4HR23antituberculosis drugsmedicine dose adverse reaction INH 1020 多发性神经炎，肝损害RFP 1015 可逆性肝损害，消化道症状。尿红色。PZA 20-30 肝损害，高尿酸血症。SM

19、 1520 听神经损害,肾损害。EMB 1520 球后视神经炎。24Tuberculosis prevention to control source of infection：smear(+)patient Pervasion BCG vaccination：to have an inoculation age is neonate.contraindicationcellular immunity deficiencyacute infectious disease convalescence stageRegion eczema or general skin diseaseOT（+）2

20、5Tuberculosis preventionDrug prevention indication:1 Close to contact open pulmonary tuberculosis in family 2 lower 3 years infant have not innoculation BCG;but OT（+）3 OT from（-）to（+）recently 4 OT(+)with toxic symptom 5 OT（+）and recently ill with measles or pertussis 6 OT（+）need long-term to take co

21、rticosteroids or immunodepressant26Tuberculosis prevention Approach 1:INH 10mg/kg course of treatment 69mo.Approach 2:INH+RFP(10mg/kg)course 3 mo.27原发性肺结核（primary pulmonary tuberculosis)28primary pulmonary tuberculosis29primary pulmonary tuberculosis30primary pulmonary tuberculosis31primary pulmonary tuberculosis32治疗33结核活动参考指标34primary pulmonary tuberculosis35 conclusion Epidemiology Diagnosis OT test therapeutic principle36