22.传染病-1完整版.ppt

Tuberculosis 渗出-浆液/纤维素性 增生-Tubercle/Tuberculous granuloma 变质-Caseous necrosis 转化规律 愈合 吸收消散—吸收好转期 纤维化钙化—硬结钙化期 恶化 浸润进展--浸润进展期 溶解播散--溶解播散期 The natural history and spectrum of tuberculosis Primary pulmonary tuberculosis--- Ghon complex. 原发综合症 The gray-white parenchymal focus is under the pleura in the lower part of the upper lobe. Hilar lymph nodes with caseation are seen on the left Secondary pulmonary tuberculosis—6 types Miliary tuberculosis of the spleen. The cut surface shows numerous gray-white granulomas. The morphologic spectrum of tuberculosis Mycobacterium avium infection in a patient with AIDS, showing massive infection with acid-fast organisms 肺外结核 肠结核---回盲部/溃疡型/增生型 结核性脑膜炎 肾结核 生殖系统结核 骨与关节结核---冷脓肿 462 Typhoid fever 伤寒 1 伤寒杆菌2 全身单核巨噬细胞系统增生性炎3 回肠末段淋巴组织病变突出 Clinical features: 5 points 持续高热 相对缓脉 脾肿大 皮肤玫瑰疹 白细胞减少 Five stages： Incubation潜伏期 Active invasion/bacteremia(1th 周 血培养+） Fastigium 高峰期 （2th 周 大便培养/肥达氏反应+） Lysis 消退 Convalescence 康复 伤寒肉芽肿 typhoid granuloma Microscopic examination reveals macrophages伤寒细胞 containing bacteria, red blood cells, and nuclear debris. Intermingled with the phagocytes are lymphocytes and plasma cells, whereas neutrophils are present near the ulcerated surface. 回肠下端集合和孤立淋巴小结的病变最常见和明显。 4期/每期一周 髓样肿胀期/伤寒肉芽肿 坏死期 溃疡期 愈合期 早期有效抗生素应用，难见典型病变。 全身单核巨噬细胞系统增生性炎 脾 The spleen is enlarged, soft, and bulging, with uniformly pale red pulp, obliterated follicular markings, and prominent sinus histiocytosis and reticuloendothelial proliferation. 肝 The liver shows small, randomly scattered foci of parenchymal necrosis in which the hepatocytes are replaced by a phagocytic mononuclear aggregate, called a typhoid nodule. These distinctive nodules also occur in the bone marrow and lymph nodes. Gallbladder colonization, which may be associated with gallstones, causes a chronic carrier state. 蜡样变性 466 慢性带菌者 / 胆囊 / “伤寒玛利” 并发症：肠出血/肠穿孔/支气管肺炎/败血症 Bacillary Dysentery 细菌性痢疾 假膜性炎/黏液脓血便 Shigella/dysente