1、结核病总论英文结核病总论英文tuberculosis factor of tuberculosis incidence rising：HIV spread.TB strain occur drug resistance.fluid population increasing.Management TB patient not perfect、prevention and cure not efficiency.Poverty、population increasing.2020/11/42etiology Mycobacterium、Acid fastness、G+、aerobe。Growth
2、 torpidity,culture need 4-6 weeks.Typing:human type、bovine type、Bird type、mouse type、main human type。way of infection：respiration tract、digestive track、skin or placenta.2020/11/43Epidemiology 1 infection sources：open pulmonary tuberculosis 2 route of transmission:by respiration way or digestion trac
3、t.3 susceptible population2020/11/44Epidemiology The factors lead Children ill with TB Contact TB amounts and toxicity.power of resistance.hereditary factor.2020/11/45pathogenesybacterial number、toxicity、immunization condition Cell-mediated immune reaction:macrophage swallow TBantigen presentation T
4、h and macrophageIL12CD+4TH1-IF-to promote mononuclear cell;to gather、activation、proliferation and differentiationto produce alexin and oxidase、digestive enzymeto kill TB2020/11/46pathogenesy IF-reinforcement CD+8、NK cells activity to phagocytosis TB.meanwhile to lead histoclasia delayed allergy:T ce
5、ll media，macrophage to be effector cell，to kill reinfection TB and cause cheesy necrosis or hole formation After Infection TB:primary disease（5%），Secondary disease（5%）,not to fall ill all live(90%)2020/11/47 diagnose Objective to discover focal。Definite disease character、size whether or not deliver
6、bacterium。2020/11/48diagnose 1 history TB toxic symptom to contact TB patient BCG vaccination acute infection:measles，pertussis Supersensitivity erythema nodosum、exanthematous conjunctivitis。2020/11/49diagnose 2：OT test agent：1/2000 or 1/10000 PPD dose：0.1ML（OT 5U）（or 1U）。position：left forearm palma
7、ris below 1/3 Infuse intracutaneous form 6-10mm hillock。4872hr observation reaction。2020/11/410diagnosis reaction 5mm(-)5mm(+)10-19mm(+)20mm(+)Super reaction:induration、vesic、local ulceration(+)。2020/11/411diagnosis significance positive reaction After BCG vaccination Older children positive reactio
8、n 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 10mm,or increase 6mm by activeness TB.。2020/11/412diagnosis negative reaction never infection TB first Infect TB during
9、 4-8 weeks false negative reaction，immune function to be pressed down。Wrong with test or PPD ineffective2020/11/413diagnosis BCG Vaccination and natural infection positive reaction condition2020/11/414diagnosis3：laboratory examination（1）find TB specimen：sputum、gastric juice、C.S.F、serous cavity liqui
10、d.method：smear、fluorescent staining、BACTEC system：culture for 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。2020/1
11、1/415diagnosis（2）immunology and molecular biology test ELISA（酶联免疫吸附试验）ELIEP（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)。2020/11/416diagnosis4：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
12、 the focus、extent and spread condition。5：bronchofiberscopy check：to definite Endotracheal membrane TB and tuberculosis of trachebronchial lymph nodes。6：lymph node puncture smear or lymphaden biopsy to diagnosis。2020/11/417tuberculotherapygeneral treatment nutrition、to take a rest。avoiding to contact
13、 infection disease。Primarily TB treatment in out-patient clinic and regularity return visit。Report epidemic situation。2020/11/418tuberculotherapyTreatmen target To kill Bacillus tuberculosis in focus to prevent disseminate。therapeutic principle early treatment Reasonable dosage Combine medicine Regu
14、larity take drug to insist on whole course Segmenting treatment.2020/11/419tuberculotherapy Anti-tuberculosis 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 bacteriost
15、atic：EMB（ethambutol)ETH(ethionamide)2020/11/420tuberculotherapy new antituberculosis to Anti drug resistant Rifamate(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 pulmo
16、nary tuberculosis usage：INH+RFPEMB course of treatment 912 month.2020/11/421化疗方案 Two stage therapy refer to：activeness primarily pulmonary TB:acute miliary tuberculosis;brain TB;intensification therapy：（purpose）Combination 34 germicide drugs Longer 34mo、shorter 2mo。continue treatment stage Combinati
17、on two drugs to keep therapeutic effect for 1218mo.(longer rang)or 4mo.(Short-rang)。2020/11/422化疗方案 short-range therapy WHO important 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
18、、2EHRZ/4HR2020/11/423antituberculosis 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 1520 听神经损害,肾损害。EMB 1520 球后视神经炎。2020/11/424Tuberculosis preventionto control source of infection：smear(+)patientPervasion BCG vaccination：to have an inoculatio
19、n age is neonate.contraindicationcellular immunity deficiencyacute infectious disease convalescence stageRegion eczema or general skin diseaseOT（+）2020/11/425Tuberculosis preventionDrug prevention indication:1 Close to contact open pulmonary tuberculosis in family 2 lower 3 years infant have not inn
20、oculation BCG;but OT（+）3 OT from（-）to（+）recently4 OT(+)with toxic symptom5 OT（+）and recently ill with measles or pertussis6 OT（+）need long-term to take corticosteroids or immunodepressant2020/11/426Tuberculosis prevention Approach 1:INH 10mg/kg course of treatment 69mo.Approach 2:INH+RFP(10mg/kg)cou
21、rse 3 mo.2020/11/427原发性肺结核（primary pulmonary tuberculosis)发综合症（primary complex)原发病灶+局部病变淋巴结+淋巴管支气管淋巴结结核(胸腔内肿大淋巴结结核)2020/11/428primary pulmonary tuberculosis本病变：渗出（炎症细胞单核细胞纤维蛋白）、增殖（结核结节结核肉芽肿）、坏死（干酪样坏死）。炎症特征：上皮样细胞结节、langerhans细胞浸润2020/11/429primary pulmonary tuberculosis 支气管内膜结核或干酪性肺结核 肿大淋巴结压迫造成肺不张或阻塞
22、性肺气肿 结核性胸膜炎 恶化：血行播散（肺或全身性粟粒性结核病）2020/11/430primary pulmonary tuberculosis疱疹性结膜炎、皮肤结节性红斑，多发性一过性关节炎 压迫症状：类百日咳样痉挛性咳嗽，喘鸣、声嘶、颈静脉怒张 体征：一般无体征、可有周围淋巴节肿大，肺部叩诊浊音，呼吸音减低，或有湿罗音。2020/11/431primary pulmonary tuberculosis菌素试验 X-线检查（胸正侧位片 原发综合症 支气管淋巴结结核（炎症型、结节型、微小型 纤维支气管镜检查（1管腔狭窄、2炎症、肉芽肿或溃疡3腔内肿块3支气管瘘，孔口火山样突起，干酪样物 实验室检查2020/11/432治疗INH+RFPEMB疗程912个月 活动性原发型肺结核短程疗法2HRZ/4HR2020/11/433结核活动参考指标岁未接种卡介苗而OT（+）者 发热及其它结核中毒症状者 排出物找到结核菌 X-线显示活动性原发性肺结核 不明原因ESR升高 支气管镜发现有明显结核病变。2020/11/434primary pulmonary tuberculosis张。2020/11/435谢谢！
