严重急性呼吸道症候群之传染途径ppt课件.ppt

SARS隔離病房 臨床表現(I) High Fever(100.4°F [38.0°C]) Sometimes is associated with chills and rigors Other symptoms: headache, malaise, and myalgia. Typically, no rash and neurologic or gastrointestinal findings Some patients have reported diarrheaor loose stool Clinical manifestations Fever: near 100% Chills, rigor, or both: 73.2% Myalgia: 60.9% Cough: 50% Headache: 50% Lymphopenia:69.6% Thrombocytopenia: 44.8% Elevated LDH: 71.0% ?CPK: 32.1% 臨床症狀(II) Incubation: 2--7 days, up to 10 days Dry, nonproductive cough or dyspnea 10%--20% of cases, the respiratory illness is severe enough to require intubation and mechanical ventilation. Chest radiographs might be normal during the febrile prodrome 臨床症狀(III) Late stages of SARS: some also have shown areas of consolidation. Early: absolute lymphocyte count is often decreased White blood cell counts : normal or decreased Approximately 50% : leukopenia and thrombocytopenia or low-normal platelet counts (50,000--150,000/μL) 臨床症狀(IV) ? CPK levels (as high as 3,000 IU/L) and hepatic transaminases (2X to 6X the upper limits of normal) LDH may be elevated Normal renal function Severity of illness :mild illness to death CXR presentationCase 1 Case 250Y/O Female Case 325Y/O Male 傳染途徑 支氣管肺泡沖洗液(BAL): 病毒最大量 痰液:SARS 少痰: 10億/CC 鼻咽分泌物:噴霧療法易傳播, 50-60% 咽喉拭子: 40-50%敏感度, 3週後10-12% 糞便:3週後陽性率 40%;越後期越增加 尿液:20% 眼液:10-20% SARS 冠狀病毒實驗室診斷 RT-PCR及定序: 50%敏感度: 1-2 天 Real Time PCR: 90%敏感度(100-1000 copies): 2 小時 抗體免疫螢光測定(IFA):97%陽性率: 2-3 weeks 抗原偵測: ELISA, 最佳,待發展 治療 第一期(1-7 days):病毒複製期:抗病毒藥物 第二期(7-14 days): 細胞激素風暴期，肺部發炎: 類固醇藥物 第三期(14 -- ) : 肺纖維化，呼吸治療 繼發細菌 / 真菌感染 Ribavirin Oral form: 2gm Stat and then 600 mg BID( 75 KG); 400 mg morning 600 mg evening( 75kg) for 10 days NEJM(92-4-7): oral 1.2gm Q 8h IV 400 mg Q8h No more an adequate management What are the current treatments and the expected outcome?(Hong Kong) The Medical Team led by Professor Joseph Sung in the Prince of Wales Hospital has gathe