Download 原发型肺结核

2009年2月全国法定传染病疫情报告
（2009年2月1日零时至2月28日24时）
发病数居前五位的病种为：肺结核、乙型肝炎、
梅毒、丙肝 、痢疾，占发病总数的90.06%
死亡数居前五位的病种为：艾滋病、肺结核、狂
犬病、乙型肝炎、丙肝，占死亡总数的91.05%。
卫生部
2009年3月10日
2008年2月全国法定传染病疫情报告
（2008年2月1日零时至2月28日24时）
发病数居前五位的病种为：肺结核、乙型肝炎、
麻疹、梅毒、痢疾，占发病总数的88.40%
死亡数居前五位的病种为：艾滋病、肺结核、狂
犬病、乙型肝炎、流脑，占死亡总数的88.82%。
卫生部
2008年3月10日
2007年2月全国法定传染病疫情报告
（2007年2月1日零时至2月28日24时）
发病数居前五位的病种为：肺结核、乙型肝炎、
梅毒、痢疾、麻疹，占报告发病总数的86.89%
死亡数居前五位的病种为：狂犬病、肺结核、乙
型肝炎、艾滋病、流脑，占报告死亡总数的
89.58%。
卫生部
2007年3月12日
2007年与2006年相比
• 与2006年相比，2007年甲乙类传染病中，呼吸道传染病和
血源及性传播传染病报告发病率分别上升3.55%和6.96%。
– 呼吸道传染病中的猩红热和麻疹上升幅度较大，病例数分别上升了
20.61%和8.88%；
– 血源及性传播传染病中的艾滋病、丙肝和梅毒上升幅度较大，病例数分
别上升了45.04%、30.01%和24.09%。
• 自然疫源及虫媒传染病和肠道传染病报告发病数分别较
2006年下降19.20%和9.19%。
Primary Pulmonary
Tuberculosis
Ⅰ Overview
Three landmark ---human control TB
 Mar,1882 Robert Koch (Germany)
 Effective chemotherapeutics
（1944 SM；
Significant progress
in chemotherapy
1950 INH）
Greatly improve
efficacy
 Protocols in Molecular Biology used in TB research
Ⅰ Overview
Tuberculotic current situation

AIDS and TB co-infection about 40-50%

AIDS and TB — Showed adverse effects on each other
 HIV lead to Potential TB expose and deteriorate
 TB become an early complication after infected with HIV
 TB lead to AIDS progression and death
 Most died of Pneumocystis carinii disease, bacterial pneumonia
 a few died of TB
Ⅰ Overview
Tuberculotic immunization
Cellular immunity
Incidence of infection depends on：
– Amount, flora, toxicum of bacterial
– Immune function of body
– Affectability（genetic factor)：
Patient with Antigen HLA-Bw35, incidence of TB
(relative risk 7.38), TBM (relative risk 15.21)
Classification of TB
 primary pulmonary tuberculosis（l型）
 Hematogenous disseminated pulmonary
tuberculosis（ll型）
 Secondary pulmonary Tuberculosis（lll型）
 Tuboerculus pleurisy;tuberculous pleuritis（lV型）
 Extrapulmonary tuberculosis（V型）
Primary Pulmonary Tuberculosis ：
one of the most common clinical type in children
primary infection
Primary Pulmonary Tuberculosis ：
 Primary Complex
 Tuberculosis of Bronchial Lymph nodes
Primary complex
原发综合征
☆
primary lesions
☆
lymphangitis
☆
Lymphadenitis
Tuberculosis of
Bronchial Lymph nodes
支气管淋巴结结核
（胸内淋巴结结核）
The scope of primary lesions are small or has been
absorbed
Ⅱ Pathology
Location:
 Right-Sided Mostly，Subpleural
 bottom of lobus superior pulmonis
 upside of lobus inferior pulmonis
basic lesion ：
Exudative lesions (渗出)
Proliferative lesions (增殖)
Caseous necrosis (坏死)
Chief Pathology characteristic:
 Epithelioid cells nodules
 Langerhans cellular infiltration
A high degree of allergy status in child
result
Extensive inflammatory around lesions
The younger, the more obvious large lesions
Pathological prognosis
1）Absorption
Complete absorption、
Calcification or Scleroma
Calcified lesions occur at least 6 to 12 months
2）progression
Expand lesions
Bronchial lymph fistula
Atelectasis、Emphysema
Tuberculous pleurisy
3）Deterioration
Hematogenous dissemination
Ⅲ、clinical manifestation
(Ⅰ)symptom：
1、 fever
2、 Poisoning
symptoms of TB
anorexia、acratia、Sweating（盗汗）
3、respiratory symptom
Little，May have a dry cough
Performance in a serious condition：
cough，A large number of sputum，
hemoptysis，dyspnea
Ⅲ、clinical manifestation
4、Oppression symptom：
• Oppress Recurrent Laryngeal Nerve —Hoarseness
• Oppress trachea, bronchus — Cough, Wheeze（喘鸣）、
Expiratory or Inspiratory obstruction
• Oppress veins — Puffiness of face
• Oppress phrenic nerve — Nausea, vomiting, hiccup
Ⅲ、clinical manifestation
(Ⅱ) signs
Pulmonary signs: less
Extra-pulmonary Signs：
Herpes conjunctivitis、Skin erythema nodosum
or Multiple one-off arthritis
Ⅳ、diagnose
Significance of early diagnosis
(Ⅰ) History：
Asked in detail about:
History of exposure and BCG vaccination,
History of infectious diseases
Notice nutritional state, immune function
(Ⅱ) clinical manifestation
Ⅳ、diagnose
(Ⅲ) PPD-Test
PPD（Protein Purified Derivative）
—纯蛋白衍化物
Method：intradermal injections 0.1ml
（含5个结核菌素单位）
(皮内注射)
(Ⅲ) PPD-Test
PPD-Test-positive clinical significance:
广泛推行BCG接种后，
• After BCG vaccination
PPD试验的诊断价值
受到一定限制
• Have been infected with TB
• Suffering from tuberculosis, there is a new disease activity
• Clinical cure, TB is not dead
• From negative to positive or the level of the reaction
<10mm to> 20mm， And an increase> 6mm, show that
there is newly infected
(Ⅲ) PPD-Test
PPD-Test-negative clinical significance：
• Not infected with TB
• In pre-allergic stage: after the initial infection 4 ~ 8
weeks
• Immune system hypofunction or temporary interference.
(False negative)
• PPD expired or technical misconduct.
Ⅳ、diagnose
(Ⅳ) X-ray examination
1、Primary complex ：
Primary lesion、
Cord-like lymphatic vessels
Swollen lymph nodes
原发综合症
女，3岁，
初染病灶在右上叶基部，支气管淋巴结肿大
(Ⅳ) X-ray examination
2、Tuberculosis of Bronchial Lymph nodes ：
Cancer type
（nodular type）
左侧支气管淋巴结结核——肿瘤型
女，6岁。母有开放性肺TB，病史2年
(Ⅳ) X-ray examination
2、Tuberculosis of Bronchial Lymph nodes ：
Infiltrating type
（Inflammation type）
右侧支气管淋巴结结核——浸润型
女，5岁。脑脊液呈典型TBM改变
支气管淋巴结结核伴发淋巴结周围炎
Ⅳ、diagnose
(Ⅴ) other auxiliary examination
1、Finding tubercle bacillus in sputum or
gastric juice
2、Superficial lymph node biopsy
3、Peripheral blood
4、ESR
5、Flexible bronchofiberscope examination
6、Antibody of TB
Ⅴ、Differential Diagnosis
1、before Chest X-ray inspection
URI、tracheitis、rheumatic fever
2、After Chest X-ray inspection
pneumonia、bronchiectasis
Ⅵ、treatment
 principle：early, combine, appropriate amount,
regularity、whole range
 Untreated TB: at least 10 persons /per 100 persons
resistant for a anti-TB drug, there is at least 1 person/per
100 persons resistant for MDR-TB (multi-drug resistant).
 Re-treated TB (previous accepted anti-TB treatment more
than one month): at least 20 persons/per 100 persons of a
drug resistance, 7 persons/per 100 persons MDR-TB.
 course：Short-term therapy
 general treatment：Rest, Nutrition, regular life
Ⅵ、treatment
 Drug therapy：6HR或9HR，
Serious：add on S2月（2SHR/4~6HR）
or Z3月（3HRZ/3~6HR）
 Drug Classification：USA
Ⅰ—Maximum effect，Minimal toxicity eg：INH、RFP
Ⅱ—Greater effect，Greater toxicity eg：SM、EMB、PZA
Ⅲ—Minimal effect，Maximum toxicity eg：KM
Ⅵ、treatment
 the basic mechanism of Short treatment ：
Fast kill tubercle bacillus in the boday
 Different propagation speed
 inside and outside of the Cells
 The basic characteristics of short-term therapy:
1、sputum culture turn negtive quickly
2、low incidence of the long-term recurrence
3、full course of treatment failure less, the high rate of
sputum culture turn negtive
4、with less drug side effects
high efficacy, less toxicity, few cost, and could
prevent drug-resistant strains
Ⅶ Prognosis
• Clinical symptoms: turn for the better after 3~6
•
months
Required 2-year improvement in pathological
recovery
quiescence
Low immunization
progression
deterioration