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天 津 医 科 大 学 授 课 教 案 (共 4 页、第 1 页) 课程名称: Internal Medicine 课程内容:Hemorrhagic Fever With Renal Syndrome 教师姓名:Sun Wenwen 职称:vice chief physician 授课日期:2013-5-2 8 时—10 时 授课对象:Students of International College of TMU 教材版本:Infectious Disease Teaching Textbook 授课方式:Multi media ISBN 7-81071-338-8 学时数: 2 听课人数:80 本单元或章节的教学目的与要求: To know the major causes of HFRS; How it is transmitted; The major manifestations of the disease; To know how to diagnose, treat and prevent HFRS. 授课主要内容及学时分配: Hantaviruses and reservoir-vectors ( 25 min); The route of virus transmitted from rats to human ( 25 min) ; The clinical manifestation of HFRS (5 stages) and lab studies ( 25 min); Treatment and prevention of HFRS ( 25 min). 重点、难点及对学生要求(包括掌握、熟悉、了解、自学) The student should be able to: describe the common means of transmission of HFRS; describe the major manifestations of HFRS; describe how to diagnose, treat and prevent HFRS. 外语词汇: Hemorrhagic fever with renal syndrome Hantaan virus 辅助教学情况: Multimedia teaching 复习思考题: The pathogen of HFRS. The clinical manifestation of severe HFRS. 参考资料: Evans and Kaslow, Viral infections of human – epidemiology and control (forth edition). Plenum Publishing Corp. 1997. 主任签字: 教务处制 天 津 医 科 大 学 授 课 教 案 (共 4 页、第 2 页) 1. Definition A disease of Europe and Asia, characterized by fevers, capillary dilatation, leakage of blood leading to hemorrhagic manifestations and in severe cases, shock and renal tubular disease. 2. Etiology 2.1 Hantaan Virus Family Bunyaviridae spherical particles Diameter: 80~160 nm lipid membrane Spikes as ligand Fragile to: heat sodium hypochlorite (1%) glutaraldehyde (2%) ethanol (70%) 2.2 Members of Genus Hantavirus Hantaan virus Seoul virus Puumala virus Belgrade-Dobrava virus 3. Epidemiology 3.1 Source of infection Reservoir: rodents and small mammals Patients generally do not serve as a source of infection. 3.2 Route of transmission 3.2.1 Transmission between rodents 3.2.2 Transmission from rodent to human being Respiratory spread Through damaged skin or mucous membrane 3.3 Crowd Susceptibility males>females may caused by their probable increased frequency of outdoor activities, which leads to contact with the infected rodents 4. Pathology 4.1 Patients who die of shock in the early stages demonstrate retroperitoneal gelatinous edema. Macroscopic hemorrhages are seen in the pituitary and right atrium. The renal medulla is congested and hyperemic 4.2 Patients who die later in the course of the disease have marked renal tubular necrosis (due to sediment of immuno-complex), leading to acute uremia. 5. Clinical Manifestations 5.1 “ features ” hemorrhagic manifestations fever renal lesions 5.2 “ pain ” headache lumbar backache orbit pain 5.3 “ flush ” facial flush neck flush upper chest flush 5.4 “ phases ” Febrile Hypotensive Oliguric Diuretic Convalescent 5.5 Lab Studies CBC of peripheral blood WBC: normal or increase atypical lymphocyte may occur thrombocytopenia Coagulation profile Urine analysis proteinuria、hematuria、cylindruria Blood chemical analysis urea nitrogen and creatinine increase usually accompanied by a rising alanine aminotransferase electrolyte and acid-base imbalance IgM or IgG antibodies become positive at the end of the first week of illness. Antibody titers peak at 2 weeks 6. Diagnosis Either IgM or IgG antibodies may be measured IgM is regarded as definitive IgG level of Convalescence phase IgG level of earlier phase ≥ 4 7. Treatment Mainly supportive – maintenance of fluid and electrolyte balance – preservation or restoration of circulating blood volume – control of elevated blood urea nitrogen and potassium – detection and treatment of secondary bacteria infection: especially in diuretic phase Broad spectrum antivirus agent ribavirin (virazole) Surgical Care exploratory laparotomy renal rupture renal biopsy 8. PREVENTI0N monitoring epidemic situation reduce the density of rodents education on personal protection vaccines 教务处制