(精选)Pulmonary Tuberculosis 肺結核教学课件.pptVIP

皮膚結核菌素試驗 Tuberculin Skin Test PPD - Purified protein derivative, 5TU 0.1cc Intra-dermal injection Delayed hypersensitivity 6-8 weeks after infection Max. induration - 48-72 hrs False negative - 25% False positive - BCG, NTM 未接種卡介苗者反應≧10 mm者為陽性，＜10 mm者為陰性；已接種卡介苗者反應≧18 mm者為陽性，＜18 mm者為陰性 Specimens Collection 標本收集 Natural sputum = 3 early morning samples Induced sputum - by hypertonic saline, nebulizer(environmental control) Gastric lavage - 50ml Urine - morning voided midstream specimen Digestion and decontamination Acid Fast Stain AFB No. Report1-2/300 fields +/-1-9/100 fields 1+1-9/10 fields 2+1-9/field 3+9/field 4+ 抹片陽性者，每西西痰約有5000-10000隻以上的細菌 培養陽性者，每西西痰約有10-100隻以上的細菌 Sensitivity 50-80% Culture Lowenstein-Jensen (egg)(4-8weeks) Middlebrook7H10, 7H11 (agar) (4-8weeks) Middlebrook 7H12 (liquid)(2weeks) Sensitivity 85% Rapid Tests 快速診斷 BACTEC - radiometric or colorimetric growth detection, 1-3 weeks (BACTEC 460, MGIT 960) Serologic test - ELISA, radioimmunoassay Amplication of nucleic acid - 5-6 hours PCR - rRNA , pacuibacillary, extrapulmonaryTMA, LCR DNA fingerprinting, RFLP (nosocomial outbreak, laboratory cross-contamination) Multiple Drug Resistant TB 抗葯性結核 In Taiwan, The overall drug resistance rate : 23.1% Resistant rates : SM 4.9% ; INH 9.2%;  EMB 1.9%; RIF 1.9% Multiple drug resistance : resistant to INH RIF1.9% Successful treatment : 53.8% 卡介苗 BCG (Bacillus Calmette-Guerin) 卡介苗是一種活的牛型結核桿菌，經減毒後注 入人體，不會使人致病，但可產生對結核病的 抵抗力 。 卡介苗是一種預防工具，尤其是預防 粟粒性結核及死亡率非常高的結核性腦膜炎 。 對一般成人的肺結核無有效證據證明有預防效果 。 卡介苗目前在台灣的地位 Mycobacteria Other Than Tuberculosis (MOTT) or NTM M. Kansasii - INH, RIF, EMB M. avium complex (MAC) - Klaricid, RIF,  EMB, SM Other slow growing NTM Rapidly growing NTM - Klaricid, amikacin Colonization of of chronic airway disease Symptomatic patients with progression of CXR finding (esp. HIV(+) patients). 院內感染結核 Inpatient medical or HIV ward 內科或愛滋病房 Emergency departments 急診室 Outpatient H