Upload
jonas-harper
View
241
Download
8
Embed Size (px)
Citation preview
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 11
Introduction of Introduction of Communicable DiseasesCommunicable Diseases
Department of Infectious Diseases,First Affiliated Hospital, School of Medicine
RUAN Bing
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 22
Introduce myselfIntroduce myself
M.D. & Ph.D RUAN BingM.D. & Ph.D RUAN Bing 阮 冰阮 冰
Professor; Doctoral advisor;
Vice-Director of Infectious
Diseases Department
Office: 87236585; Mobile :13858182230
Email: [email protected]
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 33
传染病学科简介传染病学科简介
19961996 年年
20012001 年年
20062006 年年20072007 年年
卫生部卫生部病毒性传染病病毒性传染病重点实验室重点实验室
卫生部卫生部病毒性传染病病毒性传染病重点实验室重点实验室
19561956 年年
国家重点学科国家重点学科内科学内科学
(传染病)(传染病)
国家重点学科国家重点学科内科学内科学
(传染病)(传染病)
浙江省传染病浙江省传染病重点实验室重点实验室
浙江省传染病浙江省传染病重点实验室重点实验室
传染病诊治传染病诊治国家重点国家重点实验室实验室
传染病诊治传染病诊治国家重点国家重点实验室实验室
传染病科和传染病科和传染病研究所传染病研究所
创建创建
传染病科和传染病科和传染病研究所传染病研究所
创建创建学科整体学科整体水平进一水平进一步提升!步提升!
学科整体学科整体水平进一水平进一步提升!步提升!
卫生部传染病卫生部传染病重点实验室重点实验室
卫生部传染病卫生部传染病重点实验室重点实验室
20022002 年年
5555 年前艰难创业,近年蓬勃发展年前艰难创业,近年蓬勃发展
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 44
19561956
19561956
1997199720062006
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 55
ConceptionConception
Communicable diseases:
caused by various pathogens, transmitted to
others, spread in the population
Infectious diseases:
caused by infection
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 66
Why we learn?Why we learn?
In histry, many pestilences were rampant. plague, cholera, smallpox, influenza, malaria,
schistosomiasis, kala-azar
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 77
Why we learn?Why we learn?
AchievementsYear Scientist achievement
1683 Leeuwen hoek found bacteria
1796 Edward Jenner smallpox vaccine
1876 Robert Koch bacteria of anthrax, cholera, tuberculosis
1880 Louis Pastear vaccines against anthrax, rabies
1892 Dmitri Ivanowsk filterable virus
1898 Beijerinck pick up the virus
1921 Leon Calmette, Camile Guerin B.C.G.Vaccine
1928 Alexander Fleming penicillin
1942 Selmen Waksman streptomycin
1961 Abraham cephalosporin
Controlled and eradicated: smallpox, poliomyelitis, plague, cholera, measles
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 88
Why we learn?Why we learn?
Many diseases are still popular.
— viral hepatitis, HFRS, infectious diarrhea
— zoonoses (foot and mouth disease, plague,
anthrax, rabies, tuberculosis)
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 99
Why we learn?Why we learn?
Some “old” diseases are re-emerging
— Tuberculosis
— Schistosomiasis
— Cholera
— Syphilis
— Measles
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 1010
Why we learn?Why we learn?
Some “new” diseases are emerging — Pathogens found in some non-infectious diseases
Helicobacter pyloyi
— Pathogens found in some infectious diseases
hepatitis C/E, lyme disease, legionellosis
— New appeared disease
AIDS, SARS, human avian influenza,
resistant mutants
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 1111
Why we learn?Why we learn?
bioterrorism
— Pathogens may be used as biological weapon
(anthrax, plague, smallpox, Ebola)
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 1212
Characteristics
Diagnosis
Treatment
Prevention
Communicable diseases
Infection & immunity
Epidemic process
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 1313
Infection and immunityInfection and immunity Infection and immunityInfection and immunity
13
Section 1
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 1414
Conception of infectionConception of infection
Infection : interaction between pathogen and host
Infectious disease : biochemical, physiologic,
metabolic and immunologic manifestation of the
interaction
How infection occur?
— pathogenic organisms
— human reactions
"opportunistic infection"
environmental factors
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 1515
Infection spectrumInfection spectrum
(1) Pathogen is eliminated or eradicated
(2) Covert infection
(3) Overt infection
(4) Carrier state
(5) Latent infection
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 1616
(1) Pathogen is eliminated or eradicated
Non-specific immunity barrier
Specific immunity
— active immunity
— passive immunity
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 1717
Only make the host producing specific immune response
Not having histomorphological damage
— no symptoms and signs
— no any biochemical changes
— only discovered by immunological examinations
Pathogens can be eradicated or carried
(2) Covert infection
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 1818
Make the host producing specific immune
response
Having pathological changes
Immunity can be consolidated or temporary
(3) Overt infection
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 1919
No clinical manifestation but microorganism
excreted
Various forms:
— virus or bacteria carrier
— convalescent, healthy or incubatory carrier
— acute or chronic carrier
(4) Carrier state
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 2020
Locates the pathogen but can not wipes it out
Can latently for a long time
Can occurs overt infection
What is the different point between latent
infection and carrier state ?
(5) latent infection
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 2121
The role of pathogen in the infectious processThe role of pathogen in the infectious process
(1) Invasiveness
(2) Virulence
(3) Amount of the pathogen
(4) Variability
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 2222
Invade directly — Leptospira, Filariform larva of Ancylostoma
Adhere, colonize and produce enterotoxin — Vibrio cholera
Promote spread
— Vi antigen of Salmonella typhi
(1) Invasiveness
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 2323
Toxins
— Exotoxin (Vibrio cholera , Corynebacterium diphtheriae,
Clostridium tetani)
— Endotoxin (S. typhi, Sh. dysentery)
Enzymes
(Entamoeba histolytica)
(2) Virulence
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 2424
Positive relation with pathogenicity
Least number differ greatly
(3) Quantity of pathogens
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 2525
Factors:
— environmental, drug and hereditary
Various forms:
— pathogenicity variation
— antigenic variation
— drug-resistant variation
(4) Variability
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 2626
The role of individual immunity in the infectious processThe role of individual immunity in the infectious process
(1) Non-specific immunity
(natural immunity)
— anatomic barriers, phagocytosis, humoral effects
(2) Specific immunity
(acquired, adaptive, or postinfection immunity)
— cell-mediated immunity, humoral immunity
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 2727
Epidemic process & influenced factorsEpidemic process & influenced factorsEpidemic process & influenced factorsEpidemic process & influenced factors
27
Section 2
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 2828
Essential conditions of epidemic processEssential conditions of epidemic process
(1) Sources of infection
(2) Routes of transmission
(3) Susceptibility of the population
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 2929
Patients — measles
Persons of covert infection — poliomyelitis, epidemic cerebrospinal meningitis
Pathogen carriers — typhoid fever, bacillary dysentery
Infected animals — rabies, plague, leptospirosis, scrub typhus
(1) Sources of infection
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 3030
Air transmission
Water and food transmission
Contagious transmission
Arthropod-bone transmission (blood-sucking arthropods: mosquito, lice, flea, sandfly, mite, tick)
Blood, blood products and body fluid
Mother to infant (vertical transmission)
(2) Routes of transmission
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 3131
The ratio of susceptible persons decide the crowd
susceptibility
The crowd susceptibility is relation to periodicity
of an epidemic
The periodicity of an epidemic may be prevented
by artificial active immunization
(3) Susceptibility of the population
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 3232
Influenced factors of epidemic processInfluenced factors of epidemic process
Natural factors — geography; climate; ecology
— focus of infection
— zoonosis (plague, leptospirosis, human avian influenza)
Social factors — social background; economical condition;
cultural level; anti-epidemic measures
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 3333
Characteristics of communicable diseasesCharacteristics of communicable diseases Characteristics of communicable diseasesCharacteristics of communicable diseases
33
Section 3
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 3434
Basic characteristicsBasic characteristics
(1) Pathogens
(2) Infectivity
(3) Epidemiologic feature
(4) Postinfection immunity
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 3535
Specific
Be found with natural science
advancements
(1) Pathogens
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 3636
As main distinction
“Infective period”
(2) Infectivity
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 3737
Endemic (sporadic occurrence, epidemic,
pandemic & epidemic outbreak)
Seasonal (distribution in time)
Regional (distribution in space)
Exotic
(3) Epidemiologic feature
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 3838
Specific, active, protective
Can transfer to newborns through placenta
Lasting time varies with the diseases
“Concomitant immunity” (helminthiasis)
(4) Postinfection immunity
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 3939
The phase in the development of clinical courseThe phase in the development of clinical course
(1) Incubation period
(2) Prodromal period
(3) Period of apparent manifestation
(4) Convalescent period
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 4040
Normal distribution (quarantine evidence)
Related with:
— invading quantity of pathogens
— time of the toxin (bacterial food poisoning)
— wound location (rabies)
(1) Incubation period
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 4141
Non-specific
— headache, fever, fatigue, anorexia, and myalgia
Coexist in many infectious diseases
Usually persist one to three days
even miss (sudden onset)
(2) Prodromal period
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 4242
Special symptoms and signs presented enough
— rashes, jaundice, heptomegaly, splenomegaly,
meningeal irritation signs
Especially in some acute diseases
— measles & varicella
Abortive type
— poliomyelitis, epidemic encephalitis
(3) Period of apparent manifestation
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 4343
Immunity increases to a certain level — appetite and physical strength recovered
— residual pathologic & biochemical change
— infectivity may persist (convalescent carrier)
Relapse & recrudescence
— the symptoms repeatedly and fever rise again
(4) Convalescent period
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 4444
Common symptoms and signsCommon symptoms and signs
Fever
Rash (eruption)
Toxemic symptoms
Mononuclear phagocyte system (MPS)
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 4545
Three phases — effervescence, fastigium, defervescence
Fever types — sustained — remittent — intermittent — irregular
Fever
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 4646
Exanthem and enanthem
Appearing, distribution, order, shape
Four groups: (a) mocule & papule (b) petechia & ecchymosis; (c) vesicle & pustule; (d) urticaria
Rash (eruption)
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 4747
A lot of non-specific symptoms — fever, fatigue, general malaise, anorexia, headache,
myalgia, arthralgia, skeletal pain
In severe patients: — disturbance of consciousness, delirium, meningeal
irritation, toxic encephalopathy, respiratory and
circulatory failure (septic shock)
Toxemic symptoms
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 4848
Liver
Spleen
Lymph nodes
enlarged
Reactions of MPS
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 4949
Diagnosis of communicable diseasesDiagnosis of communicable diseases Diagnosis of communicable diseasesDiagnosis of communicable diseases
49
Section 4
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 5050
Clinical dataClinical data
Detailed history
— way of an onset
— symptoms, accompanied ones
Careful physical examination
— specific signs (rose spot, eschar, Kopliks spots)
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 5151
Epidemiological dataEpidemiological data
Age, occupation, season and district
Inoculation history and past history
Occurrence in the local or the same unit
Family history
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 5252
Laboratory data Laboratory data
General laboratory detection
Detection of pathogens
Immunoassay
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 5353
Method Significance (e.g.)
leucocytes count pyogenic infections
urine routine test leptospirosis
stool routine test helminthiasis
biochemical detection viral hepatitis
General laboratory detection
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 5454
Method Pathogens (e.g.)
Direct
detection
microscope or
macroscopy
malarial parasites
Isolation with artificial culture
medium
bacteria, spirochete, fungi
Molecular
biological assay
hybridization assay,
polymerase chain
reaction (PCR)
specific viral nucleic acid
(such as HBV DNA)
Detection of pathogens
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 5555
Laboratory Significances
Serologic
test
enzyme linked immunosorbent assays (ELISA)
immunofluorescence technique
radio-immunoassay (RIA)
specific antibody
Others skin test
detection of immunoglobulin
classification of lymphocytes subsets
humoral immunity
cellular immunity
Immunoassay
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 5656
Treatment of communicable diseasesTreatment of communicable diseases Treatment of communicable diseasesTreatment of communicable diseases
56
Section 5
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 5757
General and supportingGeneral and supporting
General therapy
— Isolation, nursing care and psychologic care
Supporting therapy
— Nutrition, balance of water and electrolytes,
Enhancement of immunity by blood
and biologic products transfusion
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 5858
Anti-pathogenicAnti-pathogenic
Antibiotics
Chemical drugs
Immune serum preparations
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 5959
SymptomaticSymptomatic
Ease patient’s suffering
Reduce his energy consuming
Protect the main organs from injury
Maintain his functions
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 6060
Prevention of communicable diseasesPrevention of communicable diseases Prevention of communicable diseasesPrevention of communicable diseases
60
Section 6
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 6161
ManagementManagement of the sources of infectionof the sources of infection
Diagnosis & treatment
Isolation of patient & carrier
Report disease to CDC
In time
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 6262
Group Diseases
Group A plague, cholera
Group B 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, epidemic cerebrospinal meningitis, pertussis (whooping cough), diphtheria, tetanus in neonate, scarlet fever, brucellosis, gonorrhea, syphilis, leptospirosis, schistosomiasis, malaria
Group C influenza, mumps, rubella, acute hemorrhagic conjunctivitis, leprosy, epidemic typhus and endemic typhus, kala-azar, hydatid disease, filariasis, other infectious diarrhea
The lawful communicable diseases in China
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 6363
Interruption of the route of transmissionInterruption of the route of transmission
Achievement in:
— diseases transmitted by food, water and insets
— parasitic diseases
Methods:
— disinfection, insecticide,
hygiene measures
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 6464
Protection of susceptible populationProtection of susceptible population
Special immunological method
— active: vaccine, bacterial vaccine, toxoid
— passive: antitoxin, γ- globulin, immunoglobulin
Non-special immunological method
— improvement of nutrition
— physical training
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 6565
The procedure of a childhood program for immunization The procedure of a childhood program for immunization
Age Vaccine
Neonate BCG HBV
1 months after birth HBV
2 months after birth OPV
3 months after birth OPV DTP
4 months after birth OPV DTP
5 months after birth DTP
6 months after birth HBV
8 months after birth MV
Enhanced: 1.5-2 years DTP
4 years OPV
7 years BCG MV DT
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 6666
QuestionsQuestions
ReviewsReviews
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 6767
Pathogen is eliminated or eradicated by host immunity
Covert infection
Overt infection
Carrier state
Latent infection
Conception of infection spectrum ?
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 6868
Invasiveness
Virulence
Amount of the pathogen
Variability
The role of pathogen in the communicable diseases ?
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 6969
Sources of infection
Routes of transmission
Susceptibility of the population
Essential conditions of epidemic process with communicable diseases ?
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 7070
Conception of zoonosis ?
Some natural ecologic environment is suitable to
the transmission of infectious diseases among
wild animals. This area is called “focus of
infection”. 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.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 7171
Pathogen
Infectivity
Epidemiologic feature
Postinfection immunity
Basic characteristics of communicable diseases ?
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 7272
Incubation period
Prodromal period
Period of apparent manifestation
Convalescent period
The clinical phase in the development of acute communicable diseases ?
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 7373
Management of the sources of
infection
Interruption of the route of
transmission
Protection of susceptible population
Prevention of communicable diseases ?
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 7474
The system of communicable diseases notification?
It is an important method for discovering communicable
diseases in early, and must be followed.
According to the law of prevention and treatment of
communicable diseases of the People’s 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.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 7575
ThanksThanks!!
谢谢!谢谢!