传染病和寄生虫-2015 June-liugy.pptx

Infectious Diseases 刘国元gyliu@fudan.edu.cnPathology Department, School of Basic Medical Sciences, Fudan UniversityInfectious DiseaseCommon FeaturesEtiology: pathogenic microbes parasite epidemiologysource of infectionroute of transmission Susceptible population Pathogenesis entry celltoxin /enzyme, vessel injuryimmune response 传染病Leprosy (麻风)Syphilis(梅毒)Typhoid fever(伤寒)Bacillary dysentery（细菌性痢疾） Leprosy (麻风)IntroductionLeprosy, Hansen diseaseSlowly progressive Mycobacterium leprae 麻风杆菌Affecting the skin and peripheral nervesResulting in paralysed skin lesion, rigid and swollen nerves, disabling deformities. 麻木性皮肤损害、周围神经粗大、手足残废和畸形HistoryEpidemiology热带地区较多 Harm EtiologyM. leprae ? One of the oldest pathogen that afflict humans? Discovered in Norway in 1873 by Dr. Armauer Hansen? Acid-fast obligate intracellular bacterium 抗酸杆菌、胞内寄生? Similar to mycobacterium tuberculosisEtiology?does not grow in culture but can be grown in the armadillo (犰狳). ?Prefer low temperature (32 to 34℃) and grow slowly?virulence is based on properties of its cell wall 麻风菌素 ? Human being seems to be the only victimEpidemiology传染源 麻风病人是本病的唯一传染源，瘤型和界线类病人传染性最强。 传播途径麻风杆菌主要是通过破损的皮肤和呼吸道进入人体。 人群易感性 人类对麻风杆菌的易感性很不一致，一般儿童较成人易感，而病例多为20岁以上的成人，男性病例多于女性病例。大约95％的人具有自然免疫力TransmissionContained in secretionRespiratory pathway呼吸道 Abrasion or wounds破损的皮肤Taken up by macrophagesdisseminates through the blood PathogenesisLatent period: 2-4 years Cellular immunityHumeral immunityLepromin test 麻风菌素注射于皮肤，局部出现 迟发型变态反应，菌体的热休克蛋 白可诱发细胞免疫所致 PathogenesisA bipolar disease 根据细胞免疫强弱，分成截然不同的两种类型 tuberculoid leprosy 结核样型麻风(T-cell mediated immune response，细胞免疫强) lepromatous leprosy瘤型麻风 (Immunity anergic 免疫无反应性，体液免疫， 抗体+++) Types according to pathological changes分型Tuberculoid leprosy70%Lepromatous leprosy20%Borderline leprosy 中间界线类 少见Indeterminate leprosy未定类麻风 很少见Tuberculoid leprosy (60-70%)Intact cellular immune response Slow course, spanning decades Limited lesions Few bacilli within the lesionMainly involve s