1、 Introduction of Communicable Diseases 传染病学教研室传染病学教研室概念概念l感染性疾病感染性疾病(infectious diseases)l传染病传染病 (communicable diseases)“传染病传染病”英文近义词英文近义词l infectious diseasesl contagious diseasesl communicable diseases学习意义及重要性学习意义及重要性l 历史回顾历史回顾 传染病猖獗传染病猖獗 鼠疫鼠疫(plague),霍乱霍乱(cholera),天花天花(smallpox),流感流感(i n f l u e
2、n z a),疟 疾疟 疾(m a l a r i a),血 吸 虫 病血 吸 虫 病(schistosomiasis),热带脾大病热带脾大病(kala-azar)学习意义及重要性学习意义及重要性l 历史回顾历史回顾 积极防治卓有成效积极防治卓有成效 荷兰荷兰Leeuwen hoek于于1676年用自磨镜片创制了一架能放大年用自磨镜片创制了一架能放大266倍的原始显微镜检查了污水、齿垢、粪倍的原始显微镜检查了污水、齿垢、粪便等，发现许多肉眼看不见的微小生物，并正确地描述了微生物的形态便等，发现许多肉眼看不见的微小生物，并正确地描述了微生物的形态.法国科学家巴斯德法国科学家巴斯德(Louis P
3、asteur）1857年首先实验证明有机物质发酵和腐败是由微生物引起，而酒年首先实验证明有机物质发酵和腐败是由微生物引起，而酒类变质是因污染了杂菌所致，从而推翻了当时盛行的类变质是因污染了杂菌所致，从而推翻了当时盛行的“自然发生说自然发生说”。巴斯德的研究，开始了微生。巴斯德的研究，开始了微生物的生理学时代。物的生理学时代。德国学者郭霍德国学者郭霍(Robert Koch)。他创用固体培养基，使有可能将细菌从环境或病人排泄物等标本中分。他创用固体培养基，使有可能将细菌从环境或病人排泄物等标本中分离成为纯培养，利于对各种细菌的特性分别研究。他还创用了染色方法和实验动物感染，为发现多离成为纯培养，
4、利于对各种细菌的特性分别研究。他还创用了染色方法和实验动物感染，为发现多种传染病的病原菌，提出了著名的郭霍法则，其内容为：种传染病的病原菌，提出了著名的郭霍法则，其内容为：特殊的病原菌应在同一种疾病中查见，特殊的病原菌应在同一种疾病中查见，在健康人中不存在，该特殊病原菌能被分离培养得纯种；该纯培养物接种至易感动物，能产生同在健康人中不存在，该特殊病原菌能被分离培养得纯种；该纯培养物接种至易感动物，能产生同样病症；自人工感染的实验动物体内能重新分离得该病原菌纯培养。样病症；自人工感染的实验动物体内能重新分离得该病原菌纯培养。1892年俄国伊凡诺夫斯基发现了第一个病毒即烟草花叶病病毒。随后相继分离
5、出许多对人类和动物年俄国伊凡诺夫斯基发现了第一个病毒即烟草花叶病病毒。随后相继分离出许多对人类和动物、植物致病性病毒。、植物致病性病毒。现已控制或消灭的传染病现已控制或消灭的传染病(controlled and eradicated):天花天花(smallpox),脊髓灰质炎脊髓灰质炎(poliomyelitis),鼠疫鼠疫(plague),麻疹麻疹(measles)学习意义及重要性学习意义及重要性l 许多传染病仍广泛存在许多传染病仍广泛存在 病毒性肝炎病毒性肝炎(viral hepatitis),流行性出血热流行性出血热(HFRS),感感染性腹泻染性腹泻(infectious diarrhe
6、a),动物源性传染病动物源性传染病(zoonoses),手足口病手足口病(foot and mouth disease),鼠疫鼠疫(plague),炭疽热炭疽热(anthrax),狂犬病狂犬病(rabies),结核病结核病(tuberculosis)学习意义及重要性学习意义及重要性l 已基本消灭的传染病再现已基本消灭的传染病再现 (re-emerging or re-appeared disease)结核病结核病(tuberculosis),血吸虫病血吸虫病(schistosomiasis),霍霍乱乱(cholera),梅毒梅毒(syphilis),麻诊麻诊(measles)学习意义及重要性学
7、习意义及重要性l 新传染病的发现及输入新传染病的发现及输入 emerging disease 被认为非传染病但发现病原体被认为非传染病但发现病原体 幽门螺杆菌幽门螺杆菌(Helicobacter pyloyi)早已存在但发现病原体早已存在但发现病原体 hepatitis C/E,莱姆病莱姆病(lyme disease),军团病军团病(legionellosis)新出现新出现 AIDS,SARS,MERS,human avian influenza,resistant mutants学习意义及重要性学习意义及重要性l 生物恐怖生物恐怖 (bioterrorism)生物战剂特点生物战剂特点 致病性
8、强、致病性强、传染性强、抵抗力强、容易制备和播散传染性强、抵抗力强、容易制备和播散 常用作生物武器的病原体常用作生物武器的病原体 anthrax,plague,smallpox,Ebola流行特征流行特征CharacteristicsCharacteristics流行过程流行过程(epidemic process)诊断诊断(diagnosis)治疗治疗(treatment)预防预防(prevention)传染病传染病(communicable(communicable diseases)diseases)感染与免疫感染与免疫(infection(infection&immunity)&immu
9、nity)Characteristics of communicable diseases 第一节第一节l有病原体有病原体 pathogens -微生物微生物(microorganism)-parasite(寄生虫寄生虫)l有传染性有传染性 (infectivity)-主要特征主要特征(as main distinction)-传染时期传染时期(“infective period”)四大基本特征四大基本特征 basic characteristicsl有流行病学特征有流行病学特征 (epidemiologic feature)-外来的和地方性的外来的和地方性的(exotic&endemic)-
10、散发散发(sporadic occurrence)-流行流行,大流行大流行(epidemic,pandemic&epidemic outbreak)l有感染后免疫有感染后免疫 postinfection immunity -特异性特异性,主动的主动的(specific,active)-能通过胎盘给胎儿能通过胎盘给胎儿(can transfer to newborns through placenta)-持续时间不同持续时间不同(lasting time varies),蠕虫病蠕虫病伴随免伴随免疫力疫力“concomitant immunity”(helminthiasis)l潜伏期潜伏期 in
11、cubation period -normal distribution (quarantine evidence)-related with invading quantity of pathogens time of the toxin(bacterial food poisoning)wound location(rabies)病程发展的阶段性病程发展的阶段性 four phases l前驱期前驱期 prodromal period -nonspecific (headache,fever,fatigue,anorexia,and myalgia)-coexist in many inf
12、ectious diseases -usually persist one to three days even miss(sudden onset)l症状明显期症状明显期 period of apparent manifestation -special symptoms and signs are presented enough (rashes,heptomegaly,splenomegaly,meningeal irritation signs,jaundice)-especially in measles&varicella -顿挫型顿挫型 abortive type enter d
13、irectly into convalescent period (poliomyelitis,epidemic encephalitis)l恢复期恢复期 convalescent period -immunity increases to a certain level -appetite and physical strength recovered -residual pathologic&biochemical change -infectivity may persist (convalescent carrier)-复发复发 relapse 再燃再燃 recrudescence -
14、后遗症后遗症 sequela l发热发热 fever -three phases (effervescence,fastigium,defervescence)-fever type (sustained,remittent,intermittent,relapsing/saddle/undulent,irregular)常见的症状与体征常见的症状与体征 symptoms and signs l皮疹皮疹 rash(eruption)-exanthem and enanthem -appearing,distribution,order,shape -four groups:(a)mocule&
15、papule;(b)petechia&ecchymosis;(c)vesicle&pustule;(d)urticarial毒血症状毒血症状toxemic symptoms -fatigue,general malaise,anorexia,headache,myalgia,arthralgia,skeletal pain.-disturbance of consciousness,delirium,meningeal irritation,toxic encephalopathy,respiratory and circulatory failure(septic shock)l单核单核-吞
16、噬细胞系统反应吞噬细胞系统反应 mononuclear phagocyte system(MPS)(congestion,hyperplasia)Infection and immunity 第二节第二节l感染：感染：病原体与人体的相互作用病原体与人体的相互作用 a specific microorganism(Shigella,Salmonella)entryl感染病：感染病：感染后的临床或亚临床表现感染后的临床或亚临床表现 biochemical,physiologic,metabolic and immunologic manifestationl机会性感染机会性感染 opportuni
17、stic infection 条件致病菌条件致病菌 conditional (E.coli,Pseudomonas,Fungi)共生状态共生状态 commensalism 感染的概念感染的概念 l医院感染医院感染 nosocomial infection 510%of hospitalized patients,iatrogenic infectionl感染的形式感染的形式 首发感染首发感染 primary infection 再感染再感染 reinfection 混合感染混合感染 coinfection 重叠感染重叠感染 superinfection 继发性感染继发性感染(secondary
18、 infection)动物感染了一种病原动物感染了一种病原微生物微生物之后之后,在机体抵抗力减弱的情况下在机体抵抗力减弱的情况下,又由新侵入的或原来存在于体内的另一又由新侵入的或原来存在于体内的另一种种病原微生物病原微生物引起的引起的感染感染。感染过程的五大表现感染过程的五大表现感染谱感染谱 spectrum一、病原体被清除一、病原体被清除 eliminated or eradicated by non-specific immunity barrier specific immunity active immunity passive immunity二、隐性二、隐性/亚临床感染亚临床感染
19、cover,subclinical,inapparent,silent no symptoms and signs no biochemical changes and histomorphological damage only discovered by immunological examinations common in(poliomyelitis，乙脑，乙脑epidemic encephalitis B)eradicated or carrier(typhoid fever,dysentery,HBV)三、显性三、显性/临床感染临床感染 overt,clinical,apparen
20、t immune responses histomorphological damage and pathological changes clinical manifestation(measles,varicella or chikenpox)consolidated immunity(measles,hepatitis A,typhoid fever)temporary immunity(bacillary dysentery,influenza)四、病原携带状态四、病原携带状态 carrier state no clinical manifestation but microorgan
21、ism excreted one of the main sources of infection (伤寒伤寒typhoid fever,痢疾痢疾dysentery,乙型肝炎乙型肝炎hepatitis B)virus carrier and bacteria carrier convalescent carrier,healthy carrier and incubatory carrier acute and chronic carrier 五、潜伏性感染五、潜伏性感染 latent infection locates the pathogen but can not wipes it ou
22、t can occurs overt infection when immunity decreased (单疱单疱herpes simplex,带状疱疹带状疱疹herpes zoster,疟疾疟疾malaria,结结核核tuberculosis)the microorganism can not be excreted潜伏潜伏感染感染显性显性感染感染病原病原携带状态携带状态 隐性感染隐性感染 清除病原体清除病原体 感染过程中病原体的作用感染过程中病原体的作用 role of pathogen决定疾病的两大因素决定疾病的两大因素-宿主免疫功能宿主免疫功能 immunity-病原体致病能力病原体
23、致病能力 pathogenicity 病原体的四大致病能力病原体的四大致病能力1.1.侵袭力侵袭力 invasiveness invade directly(钩体钩体Leptospira,钩虫丝状蚴钩虫丝状蚴Filariform larva of Ancylostoma)adhere,colonize and produce enterotoxin(Vibrio cholera)promote spread(Vi antigen)2.2.毒力毒力 virulence 毒素毒素 exotoxin(enterotoxin of Vibrio cholera)(Corynebacterium dip
24、htheriae,Clostridium tetani)endotoxin(S.typhi,Sh.dysentery)其他毒力因子其他毒力因子 enzymes(Entamoeba histolytica)3.3.数量数量 quantity of pathogens positive relation with pathogenicity least number differ greatly4.4.变异性变异性 variability factors:environmental,drug and hereditary decreased by artificial culture(BCG)in
25、creased by repeated spread(pneumonic plague)mutants:influenza,HCV,HIV l保护性免疫应答保护性免疫应答 -非特异性非特异性 anatomic barriers,phagocytosis,humoral effects -特异性特异性 cell-mediated,humoral l变态反应变态反应 -特异性特异性感染过程免疫应答的作用感染过程免疫应答的作用Epidemic process&influenced factors第三节第三节l传染源传染源 sources of infection -patients(measles)
26、-persons of covert infection (poliomyelitis,epidemic cerebrospinal meningitis)-pathogen carriers (typhoid fever,bacillary dysentery)-infected animals (rabies,plague,leptospirosis,scrub typhus恙虫病恙虫病)流行过程的基本条件流行过程的基本条件 three basic links l传播途径传播途径 routes of transmission -respiratory duct:air,droplet nu
27、clei,dust particle -digestive duct:water,food,fly -contagious transmission:direct contagion(water and soil)daily-life contagion(hand,tool and toy)-arthropod-bone transmission:(mosquito,lice虱子虱子,flea,sandfly,mite,tick)-blood,blood products and body fluid -mother to infant:(vertical transmission)l人群易感
28、性人群易感性 susceptibility of the population 受易感者比例决定受易感者比例决定susceptible person 与流行周期性相关与流行周期性相关periodicity of an epidemic 与人工自动免疫相关与人工自动免疫相关 artificial active immunization l自然因素自然因素 natural factors -geography,climate and ecology -疫源地疫源地 focus of infection 自然疫源型传染病自然疫源型传染病/人兽共患病人兽共患病 zoonosis (plague,lep
29、tospirosis,human avian influenza)l社会因素社会因素 social factors -social background;economical condition;-cultural level;anti-epidemic measures 影响流行过程的因素影响流行过程的因素 influenced factors Diagnosis of infectious diseases 第四节第四节l详尽的病史详尽的病史 detailed history -way of an onset -symptoms,accompanied ones l细致的体检细致的体检 c
30、areful physical examination -specific signs(rose spot,eschar焦痂焦痂，Kopliks spots,gastrocnemius muscle tenderness腓肠肌触痛试验腓肠肌触痛试验)临床资料临床资料clinical data l发病年龄、职业、季节、地区发病年龄、职业、季节、地区 age,occupation,season and districtl预防接种史、过去史预防接种史、过去史 inoculation history and past historyl当地流行情况或集体发病史当地流行情况或集体发病史 occurrenc
31、e in the local or the same unit l家族史家族史 family history流行病学资料流行病学资料epidemiological data l 一般检查一般检查 三大常规三大常规 blood,stool and urine routine test 生化检查生化检查 biochemical detection 实验室检查实验室检查laboratory data l 病原学检查病原学检查 直接检出直接检出 microscope or macroscopy 培养分离培养分离 cultured or isolated 分子生物学检测分子生物学检测 分子杂交分子杂交
32、hybridization assay 聚合酶链反应聚合酶链反应 polymerase chain reactionl免疫学检测免疫学检测 血清学试验血清学试验 serologic test agglutination,precipitation,complement fixation test,neutralization,immunofluorescence technique,radio-immunoassay(RIA),enzyme linked immunosorbent assays(ELISA)其他免疫学检测其他免疫学检测 skin test,detection of immun
33、oglobulin classification of lymphocytes subsets Treatment of infectious diseases 第五节第五节ltreatment and nursing with isolation and disinfectionlgeneral and symptomatic treatment with specific treatment治疗原则治疗原则 principle of treatment l 一般及支持疗法一般及支持疗法 general and supporting -isolation,nursing care and p
34、sychologic care -nutrition,balance of water and electrolytes l 病原病原/特效疗法特效疗法 anti-pathogenic -antibiotics -chemical drugs -immune serum preparations治疗方法治疗方法therapy l 对症疗法对症疗法 symptomatic -ease a patients suffering -reduce his energy consuming -protect the main organs from injury -maintain their func
35、tions l 中医中药中医中药 Chinese traditional (adjusting function)Prevention of infectious diseases 第六节第六节l早发现、早诊断早发现、早诊断l及时上报防疫部门及时上报防疫部门 法定报告人法定报告人 义务报告人义务报告人l法定传染病法定传染病 中华人民共和国传染病防治法中华人民共和国传染病防治法 （2004-12-01起施行）起施行）控制传染源控制传染源management of the sources of infection Group Diseases 甲类甲类 Group A（强制管理）（强制管理）pla
36、gue,cholera乙类乙类 Group B（严格管理）（严格管理）infectious atypical pneumonia(SARS),AIDS,viral hepatitis,poliomyelitis,avian influenza,measles,epidemic hemorrhagic fever,rabies,epidemic encephalitis B,dengue fever,anthrax,bacillary and amebic dysentery,pulmonary tuberculosis,typhoid fever and paratyphoid fever,e
37、pidemic cerebrospinal meningitis,pertussis(whooping cough),diphtheria,tetanus in neonate,scarlet fever,brucellosis,gonorrhea,syphilis,leptospirosis,schistosomiasis,malaria 丙类丙类 Group C（监测管理）（监测管理）influenza,mumps,rubella,acute hemorrhagic conjunctivitis,leprosy,epidemic typhus and endemic typhus,kala
38、-azar,hydatid disease,filariasis,other infectious diarrhea The lawful communicable diseases in China 按甲类处置按甲类处置l 甲类传染病甲类传染病l 乙类（肺型炭疽、乙类（肺型炭疽、SARSSARS、人禽流感）、人禽流感）l 其他乙类（如有必要），或本地区新发传染病其他乙类（如有必要），或本地区新发传染病 国务院批准、公布后国务院批准、公布后l 国家已宣布消灭的传染病国家已宣布消灭的传染病报告时间报告时间l 甲类：城镇甲类：城镇2 2小时内、农村小时内、农村6 6小时内小时内l 其他乙类：城镇其
39、他乙类：城镇6 6小时内、农村小时内、农村1212小时内小时内l 丙类丙类/其他传染病：其他传染病：2424小时内小时内2004-05-31卫生部卫生部突发公共卫生事件与传染病监测信息报告突发公共卫生事件与传染病监测信息报告 规定通过规定通过“传染病疫情监测信息系统传染病疫情监测信息系统”上报上报医疗机构发现甲类传染病时（一）对病人、病原携带者，予以隔离治疗，隔离期限（一）对病人、病原携带者，予以隔离治疗，隔离期限 根据医学检查结果确定；根据医学检查结果确定；（二）对疑似病人，确诊前在指定场所单独隔离治疗；（二）对疑似病人，确诊前在指定场所单独隔离治疗；（三）对医疗机构内的病人、病原携带者、疑
40、似病人的（三）对医疗机构内的病人、病原携带者、疑似病人的密切接触者，在指定场所进行医学观察和采取其他必密切接触者，在指定场所进行医学观察和采取其他必要的预防措施。要的预防措施。l 接触者接触者 检疫、密切观察、药物预防检疫、密切观察、药物预防/预防接种预防接种l 病原携带者病原携带者 治疗、教育、调整岗位、随访观察治疗、教育、调整岗位、随访观察l 主要针对主要针对 消化道传染病消化道传染病虫媒传染病虫媒传染病寄生虫病寄生虫病 transmitted by digestive tract and insets,as well as many parasitic diseases l 方法方法 消
41、毒消毒杀虫杀虫卫生措施卫生措施 disinfection,insecticide,hygiene measures(water,food,environmental hygiene)切断传播途径切断传播途径interruption of the route of transmissionl 特异性主动免疫特异性主动免疫 疫苗、菌苗、类毒素疫苗、菌苗、类毒素 vaccine,bacterial vaccine,toxoid,l 特异性被动免疫特异性被动免疫 抗毒素、丙球、高滴度免球抗毒素、丙球、高滴度免球 antitoxin,-globulin,immunoglobulin保护易感人群保护易感人
42、群 protection of susceptible population The procedure of a childhood program for immunization Age Vaccine Neonate BCG HBV1 months after birth HBV2 months after birth OPV3 months after birth OPV DTP4 months after birth OPV DTP5 months after birth DTP6 months after birth HBV8 months after birth MVEnhan
43、ced:1.5-2 years DTP 4 years OPV 7 years BCG MV DT常用计划外疫苗常用计划外疫苗l口服轮状病毒疫苗：口服轮状病毒疫苗：9个月后；以后每年服食一次l麻腮风三联疫苗：麻腮风三联疫苗：1岁；4周岁第二针lB型流感嗜血杆菌：型流感嗜血杆菌：14个月后一针l流脑疫苗：流脑疫苗：2周岁；3年后第二针l水痘疫苗：水痘疫苗：2周岁后一针l甲肝疫苗：甲肝疫苗：2周岁后；3周岁第二针；其余年龄按其有效期l流感疫苗：流感疫苗：6个月2岁11个月一针；隔一个月后第二针；3周岁以上每年一针l风疹疫苗：风疹疫苗：一周岁一针l乙脑疫苗：乙脑疫苗：一周岁一针思考题思考题Some
44、reviewsl Pathogen is eliminated or eradicated by host immunity l Covert infection l Overt infectionl Carrier state l Latent infection Conception of infection spectrum?l Invasiveness l Virulence l Amount of the pathogen l Variability The role of pathogen in the communicable diseases?l Sources of infe
45、ction l Routes of transmission l Susceptibility of the populationEssential conditions of epidemic process with communicable diseases?Conception of zoonosis?Some natural ecologic environment is suitable to the transmission of infectious diseases among wild animals.This area is called“focus of infecti
46、on”.The human race may be infected when they get into these areas.This disease is called“zoonosis”,such as plague,leptospirosis,human avian influenza,and so on.l Pathogen l Infectivity l Epidemiologic feature l Postinfection immunity Basic characteristics of communicable diseases?l Incubation period
47、 l Prodromal period l Period of apparent manifestation l Convalescent period The clinical phase in the development of acute communicable diseases?l Management of the sources of infection l Interruption of the route of transmission l Protection of susceptible population Prevention of communicable dis
48、eases?The system of communicable diseases notification?It is an important method for discovering infectious diseases in early,and must be followed.According to the law of prevention and treatment of communicable diseases of the Peoples Republic of China and its detailed rules and regulation,the lawful infectious diseases were divided into three groups.Group A(plague,cholera)must be reported in 2 hours in town and 6 hours in rural area,while Group B in 6 and 12 hours,and Group C in 24 hours as well.
