肺部感染性疾病.解决方案.ppt

X线特点 肺部多态性的浸润影，呈节段性分布 可呈间质性肺炎改变 3-4周病灶可自行消散 3周后 Diagnosis 症状、体征和X线表现缺乏特异性 刺激性咳嗽经普通抗菌治疗效果不佳者，应考虑本病 血清学检查是本病的主要诊断手段 冷凝集试验 支原体抗体检测 支原体抗原PCR检测 Therapy 首选红霉素为代表的大环内酯类药物 思考题 1. CAP与HAP的定义及区别？ 2. 重症肺炎诊断标准？ 3. 如何评估肺炎的严重程度 ？ 4. 肺炎球菌肺炎的病理特征？ 5. 各型肺炎的首选抗生素？ 病例分析 男性,28岁,因高热,咳嗽,胸痛三天入院。三天前淋雨后出现高热,体温达39.2℃,畏寒,咳嗽,伴右侧胸痛,无皮疹、咯血。 既往体健。 体查:BP 100/60mmHg,急性热病容,口角疱疹,右下肺叩诊呈浊音,可闻及支气管呼吸音。心率96次/分,律齐,无杂音。腹平软,无压痛,肝脾不大。余 － 。 血象: WBC 11.0×109/L N 86% X线:右下肺大片密度增高影 B超:右胸腔少许积液。 其初步诊断及依据 ? * * * VRIs, also called “the common cold” or rhinosinusitis, are recognized as the most common infectious illness in humans and a major cause of acute morbidity in individuals of all ages worldwide.1 Viral pathogens associated with these infections include the picornaviruses, influenza viruses, parainfluenza viruses, respiratory syncytial virus RSV , adenoviruses, and coronaviruses. The ability to detect these viruses with advanced techniques such as reverse-transcription polymerase chain reaction RT-PCR assays has allowed the laboratory identification of specific viruses that cause various respiratory syndromes. Rhinoviruses RVs, one of the genera of the picornavirus family are the most common cause of VRI symptoms. Picornaviruses have been isolated in up to 82% of persons with self-reported cold symptoms during the peak fall season.2 Most picornaviruses identified were RVs; some were enteroviruses. Those not identified were assumed to be RV. In this study, picornavirus RNA was detected in 46% of the culture-negative nasal wash specimens. From 70% to 88% of human RV infections result in symptomatic respiratory episodes characterized by rhinorrhea, nasal obstruction, sore throat, cough, and hoarseness, without systemic symptoms such as fever.1,3 1. Monto AS, Fendrick AM, Sarnes MW. Respiratory illness caused by picornavirus infection: a review of clinical outcomes. Clin Ther. 2001;23:1615-1627. 2. Arruda E, Pitk?ranta A, Witek T Jr, Doyle CA, Hayden FG. Frequency and natural history of rhinov