痰细菌及抗酸菌检查菌阴性PPD试验强阳性.PPT

TB is an ancient infectious disease caused by Mycobacterium tuberculosis. It has been known since 1000 B.C., so it not a new disease. Since TB is a disease of respiratory transmission, optimal conditions for transmission include: overcrowding poor personal hygiene (卫生) poor public hygiene Pathological change TUBERCULOSIS PULMONAR Pathogenicity Lipid: Phosphatide, mycolic acid(分支菌酸), cord factor ,Wax D. Protein: tuberculin, protein—Wax D can induce allergic response. Disease: Primary tuberculosis and post-primary tuberculosis. Once inhaled by a tuberculin free person, the bacilli multiply 4 -6 weeks and spreads throughout the body. The bacilli implant in areas of high partial pressure of oxygen: lung renal cortex reticuloendothelial system This is known as the primary infection. When a persons immune system is depressed., a secondary reactivation occurs. 85-90% of the cases seen which are of secondary reactivation type occurs in the lungs. Diagnosis  病原学诊断（1）涂片抗酸染色镜检法 （2）培养法 （3）药敏试验 辅助性诊断（1）免疫学 （2）血清学 （3）酶学 组织学诊断（1）肺的液体活组织检查 （2）肺活组织检查 （3）胸膜活组织检查淋巴结检查 影像学诊断（1）普通X线检查 （2）CT （3）磁共振成像 Diagnosis  OT( old tuberculin): TB Glycerol broth 4-8 weeks 100 ℃,1h filtration concentration(1/10) PPD (purified protein derivative): TB special media 6-8 weeks TCA precipitation PPD injection 24-48h Induration, erthyema “-”---?5mm:1) no TB infection 2) early stage of primary infection 3) serious infection of tuberculosis 4) virus infection; tumor, ADIS 5) use of immunosuppressive agents “+”---5mm?15mm: hypersensitive to M. tuberculosis; immunity “++”---?15mm: active TB perhaps Prevention Step One