1、n History taking：A boy,4 years old，born in the countryside.Fever last for 4 days，convulsion and confusion last about 6 hours.Physical examination：T 40.5，R 30bpm，P 120bpm，BP100/60mmHg.Unconsciousness,conjunctival edema,lungs can be heard wheezes.Muscle hypertonia,knee hyperreflexia,Babinski sign(+)Ot
2、her history?Accessory examination?n Japanese encephalitis(JE),an acute infectious disease caused by the mosquito-borne Japanese encephalitis virus(JEV)and featured as inflammation in brain parenchyma.n Fever,confusion,coma,convulsion,pathological reflex and meningeal irritation.Respiratory failure i
3、n severe cases,high mortality,and10%result in permanent neuropsychiatric sequelea.n A single stranded RNA,40-50nm,11 kilobases genomes.RNA genome is packaged in the capsid protein forming the core of the virus.n The genomes also encodes several nonstructural proteins(NS1,NS2a,NS3,NS4a,NS4b,and NS5)n
4、 JEV can be killed by disinfectant,100 2 minutes or 56 30 minutesn Antigenic stability,infection can produce complement-binding antibodies,neutralizing antibodies and hemagglutination inhibition antibodies,contribute to clinical diagnosis and epidemiological investigationn Sources of infection:JE is
5、 a zoonosis,mosquitoes become infected by feeding domestic pigs and wild birds infected with the JEV.JEV is amplified in the blood systems of the domestic pigs and wild birds.Pigs are the improtant amplified and reservoirs.n Other reservior includes cow,sheep,horse,duck,goose and chicken.n Route of
6、transmission:the bite of an infected mosquito,primarily Culex species.Humans are a dead-end host in the JEV tramsmission cycle.JEV is not transmitted from person-to-person.Only domestic pigs and wild birds are carriers of the JEV.n Susceptible population:Generally susceptible,especially residents of
7、 rural areas in endemic location,mostly asymptomatic.The ratio of patients and latent infection was 1:1000-2000.Pre-existing antibodies.Countries that still have periodic epidemics include India,Cambodia,Nepal and so on.Humans are a dead-end host in the JEV tramsmission cycle.EpidemiologyUnconscious
8、ness,conjunctival edema,lungs can be heard wheezes.Anterior fontanel bulging,papilledemaAntigenic stability,infection can produce complement-binding antibodies,neutralizing antibodies and hemagglutination inhibition antibodies,contribute to clinical diagnosis and epidemiological investigationThe gen
9、omes also encodes several nonstructural proteins(NS1,NS2a,NS3,NS4a,NS4b,and NS5)Unconsciousness,conjunctival edema,lungs can be heard wheezes.Infusion supplement water,electrolytes,vitamins.Cerebrospinal fluid(CSF)：lumbar puncture to obtain CSF samples.Coma increasedThe primary stage(1-3 days):onset
10、 was sudden with high fever,up to 39-41 in 1-2 days accompanied headache and malaise.Respiratory secretions Infarct:suction,atomization inhalation of-chymotrypsin;with bronchospasm may be 0.Sources of infection:JE is a zoonosis,mosquitoes become infected by feeding domestic pigs and wild birds infec
11、ted with the JEV.Susceptible population:Generally susceptible,especially residents of rural areas in endemic location,mostly asymptomatic.The ratio of patients and latent infection was 1:1000-2000.Symptomatic treatmentThe convalescence stage：Other nervous symptoms and signsEncephalitis bThe incidenc
12、e of about 5%to 20%.n Epidemic feature:most cases in temperate and subtropical areas occur from June to September,while in tropical areas occur throughout the year.n Five genotypes:genotypes I,II,III,IV,V.Genotypes I and III occur principally in temperate,epidemic areas,and genotype II and IV occur
13、principally in tropical,endemic regions.JEVMononuclear macrophages multiplyviremiaInvade the CNSNot invade the CNSIncidenceLatent infectionJEVDirect invasionAntigen-antibody binding to the immune attackNerve cell lesionsVascular sheath formationThalamus,basal ganglia,brain stem,cerebellum,hippocampu
14、s,cerebral cortexGlialcell proliferationIncubation period of 5-15 days.the vast majority of infections are asymptomatic,only 1 in 250 infections develop into encephalitis.Typical manifestation:there are four stagesThe primary stage(1-3 days):onset was sudden with high fever,up to 39-41 in 1-2 days a
15、ccompanied headache and malaise.Anorexia,nausea,or abdominal pain.Apathy and neck rigidity.n The proximity stage(fourth to tenth days)Hyperthermia Conscious disturbance Convulsion Respiratory failure Other nervous symptoms and signs Circulation failuren The proximity stage：Hyperthermia:acute onset;m
16、ore than 40,lasts 7-10 days generally and some grave cases can last for 3 weeks.The higher temperature,the longer course,the more serious of JE.n The proximity stage Conscious disturbance：Lethargy,delirium,coma,and disorientation are main presentations Appears mostly at the 3-8 days,lasting for almo
17、st 1 week A positive corralation between the serious and the lasting time of coma and the gravity of JE and prognosisGeneral treatmentMuscle hypertonia,knee hyperreflexia,Babinski sign(+)And appropriate treatment with antibiotics such as bacterial infection.5，R 30bpm，P 120bpm，BP100/60mmHg.Infusion s
18、upplement water,electrolytes,vitamins.Accessory examination?Fever last for 4 days，convulsion and confusion last about 6 hours.History taking：Clinical manifestationsThe living environmentClinical manifestationsInfusion supplement water,electrolytes,vitamins.Administer the last dose of vaccine at leas
19、t 10days prior to travel in an endemic area.Glialcell proliferationA boy,4 years old，born in the countryside.Chloride and glucose are normal,high protein,cell count 50500*106/LCerebral edema:dehydration,20%mannitol 1-2g/Kg,intravenous infusion,4-6h time,while combined with adrenal cortex hormones,fu
20、rosemide,50%GS,to reduce vascular permeability,Prevention of brain edema and dehydration agent rebound applicationthe vast majority of infections are asymptomatic,only 1 in 250 infections develop into encephalitis.The incidence of about 5%to 20%.Laboratory examinationsThe recent local similar patien
21、ts.n The proximity stage Convulsion：Causes:high fever,cerebral edema,brain parenchymal inflammation One or more focal/asymmetric signs appearing in the first few days Light:the face,lips,local convulsions,severe cases of the body About 30%of survivors have frank persistent motor language impairment.
22、Respiratory failure:caused by inflammatory of brain parenchyma,hypoxia,cerebral edema,acute intracranial hypertension and cerebral hernia Cerebral henia：Spitting vomiting,convulsions Coma increased Pupil changes.Anterior fontanel bulging,papilledeman The proximity stage：Circulation failure:rarely,ta
23、chycardia,hyper or hypotension and rarely ECG evidence of pericarditis.Other nervous symptoms and signs:superficial reflex disappears or weakens;deep reflex accentuations first and the disappears and there are symptoms and meningeal irritation.hyperthermiaconvulsionRespiratory failureAre critical pr
24、esentations of JE and respiratory failure is the leading cause of deathn The convalescence stage：Defervescence of fever and neurologic improvement It usually lasts for at least two weeksn The sequelae stage：the existence of neuropsychiatric symptoms after 6 months。The incidence of about 5%to 20%.Cli
25、nical manifestationsn White blood cell:grows up to 1020109/L,neutrophil occupied more than 80%.Some patients have normal WBC counts.n Cerebrospinal fluid(CSF)：lumbar puncture to obtain CSF samples.n Cerebrospinal fluid(CSF)：The opening pressure is usually normal but may be raised.Mononuclear white b
26、lood cells may be 50500106/L;Glucose levels are normal;Protein levels are mildly elevated in most cases,often less than 900mg/dln Antiboby detection:Specific IgM antibodies is the standard diagnostic test for JE,nearly 100%sensitivity;IgM antibody levels may be found even within 7 days of symptoms.F
27、alse-negative results may occur if the samples are testd too early.Some cross-reactivity may arise from other flaviviruses and from JE and yellow fever vaccinations General treatment:oxygen.The genomes also encodes several nonstructural proteins(NS1,NS2a,NS3,NS4a,NS4b,and NS5)Muscle hypertonia,knee
28、hyperreflexia,Babinski sign(+)Control the source of infection:Vaccine the pigs before the epidemic seasonCase reportLatent infectionWBC analysisClinical manifestationsHistory taking：Anus dry smear of pus cells,blood cultures of ShigellaRespiratory failure:caused by inflammatory of brain parenchyma,h
29、ypoxia,cerebral edema,acute intracranial hypertension and cerebral herniaDirect invasionEncephalitis bAdverse reactions include local pain and redness,fever,gastrointestinal symptoms,headacheNucleic acid detection:detection of viral genome by RT-PCR is easier to perform and highly reliable with 100%
30、sensitivity,JEV has been isolated up to even almost 4 months after clinical symptoms have begunAuxiliary examination：WBC15109/L，N82。The living environmentThe proximity stage：The changes,which consist of perivascular congestion and hemorrhage,may be diffuse or focal,but they are seen predominantly in
31、 cortical gray and deep gray matterControl the source of infection:Vaccine the pigs before the epidemic seasonOther nervous symptoms and signsAntigenic stability,infection can produce complement-binding antibodies,neutralizing antibodies and hemagglutination inhibition antibodies,contribute to clini
32、cal diagnosis and epidemiological investigationPigs are the improtant amplified and reservoirs.Cerebral henia：Direct invasionThank you！Respiratory blockage:suction,oxygen,if necessary,tracheotomyGenotypes I and III occur principally in temperate,epidemic areas,and genotype II and IV occur principall
33、y in tropical,endemic regions.The proximity stage：Antigenic stability,infection can produce complement-binding antibodies,neutralizing antibodies and hemagglutination inhibition antibodies,contribute to clinical diagnosis and epidemiological investigationHistory of vaccinationCase reportThe genomes
34、also encodes several nonstructural proteins(NS1,NS2a,NS3,NS4a,NS4b,and NS5)And appropriate treatment with antibiotics such as bacterial infection.Cerebrospinal fluid(CSF)：The opening pressure is usually normal but may be raised.Case reportClinical manifestationsControl the source of infection:Vaccin
35、e the pigs before the epidemic seasonEpidemic feature:most cases in temperate and subtropical areas occur from June to September,while in tropical areas occur throughout the year.Case reportCase reportDignosis:JEVn Nucleic acid detection:detection of viral genome by RT-PCR is easier to perform and h
36、ighly reliable with 100%sensitivity,JEV has been isolated up to even almost 4 months after clinical symptoms have begunn Inmaging studies:MRI and CTn Epidemiology data:rigorous seasonality:summer and autumn;less than 10 years old are more susceptible but more adult patients are seen now n Clinical f
37、eatures：acute onset headache,vomitting,hyperthermia,convulsion and positive pathologic reflex and meningeal irritation signn Laboratory examinations：peripheral blood picture,CSF,serum antibodies,EEG,CT and MRI,brain biopsy n Virological investigation:JEV is difficult to be separated from blood and C
38、SF.JEV antigen can be detected in such body fluid using PCR.Toxic bacillary dysenteryTuberculous meningitisPurulent meningitisEncephalitis bOnsetAcute，24 hour peakChronic,long course1-2 peak1-2 peakSeasonSummer to autumnNon-seasonalwinter and springSummer to autumnCSFNormalChloride and glucose are l
39、ow,high protein,cell count 50*106/LChloride and glucose are low,high protein,cell count 1000*106/LChloride and glucose are normal,high protein,cell count 50500*106/LPathogenAnus dry smear of pus cells,blood cultures of ShigellaCSF film smear TBCSF smear staining bacteriaCSF bacterial testing was neg
40、ative.Specific IgM antibodiesn General treatmentn Symptomatic treatment hyperthermia,convulsion,respiratory failure n General treatment Coma patients should pay attention：Oral cleaning Prevent secondary bacterial infection Prevent bed sores occur Protect the cornea Anti-falling bed prevent the tongu
41、e bitten Note that water,electrolytes,acid-base balance,but not too much infusion volume to prevent brain edeman hyperthermia：Lower the room temperature Physical cooling:ice or alcohol cool saline With convulsions:hibernation therapy(chlorpromazine+promethazine)n convulsion：Cerebral edema:dehydratio
42、n,20%mannitol 1-2g/Kg,intravenous infusion,4-6h time,while combined with adrenal cortex hormones,furosemide,50%GS,to reduce vascular permeability,Prevention of brain edema and dehydration agent rebound application Respiratory blockage:suction,oxygen,if necessary,tracheotomyn Respriatory failure：Brai
43、n edema:dehydrating agent Central respiratory failure:available respiratory stimulants Improve microcirculation,reduce cerebral edema:vasodilatorsn Respriatory failure：Respiratory secretions Infarct:suction,atomization inhalation of-chymotrypsin;with bronchospasm may be 0.25%-0.5%isoproterenol inhal
44、ation.And appropriate treatment with antibiotics such as bacterial infection.If necessary,endotracheal intubation or incision,artificial respiration ventilationn Recovery and sequelae of treatment:acupuncture,physical therapy,hyperbaric oxygen therapyn Control the source of infection:Vaccine the pig
45、s before the epidemic seasonn Cut off the transmission:anti-mosquito,mosquito control.n Protection of susceptible populations,vaccination injectionsn Vaccination injections:the current dosing schedule for patients aged 3 years or older is 1ml subcutaneously on days 0,7,and 30(0.5ml in patients aged
46、1-2y).Administer the last dose of vaccine at least 10days prior to travel in an endemic area.n Adverse reactions include local pain and redness,fever,gastrointestinal symptoms,headachen History taking：A boy,4 years old，born in the countryside.Fever last for 4 days，convulsion and confusion last about
47、 6 hours.Physical examination：T 40.5，R 30bpm，P 120bpm，BP100/60mmHg.Unconsciousness,conjunctival edema,lungs can be heard wheezes.Muscle hypertonia,knee hyperreflexia,Babinski sign(+)Other history?Accessory examination?n Other history Before the disease with or without diarrhea,cough,wound infection
48、With or without history of chronic fever and cough History of vaccination The living environment With or without similar patientsLaboratory examinationsProtect the corneaHistory taking：Appears mostly at the 3-8 days,lasting for almost 1 weekCase reportAnterior fontanel bulging,papilledemaRecovery an
49、d sequelae of treatment:acupuncture,physical therapy,hyperbaric oxygen therapy5，R 30bpm，P 120bpm，BP100/60mmHg.Respriatory failure：Causes:high fever,cerebral edema,brain parenchymal inflammationPhysical examination：T 40.Fever last for 4 days，convulsion and confusion last about 6 hours.Other nervous s
50、ymptoms and signsOther history?Oral cleaningThe incidence of about 5%to 20%.Incubation period of 5-15 days.Light:the face,lips,local convulsions,severe cases of the bodySummer to autumnThe sequelae stage：Pigs are the improtant amplified and reservoirs.Epidemiologyn Take into account the supplementar
