1、Scrub Typhus （恙虫病） Department of Infectious Diseases, the Third Affiliated Hospital Li Gang,Definition,Acute febrile infectious diseaseCaused by Rickettsia tsutsugamushiTransmitted by the bite of chiggersSource of infection: RatsCharacterized by fever, eschar, rash,and lymphadenopathy,Etiology,Intra
2、cellular organism Propagated in mice, some cells Antigenically diverse microorganism Common antigen with Proteus OX-K Low resistance,Epidemiology, Source of infection: Rats Vector: Mite The life cycle: ovum, larva, pupa, naiad and imago Only its larva (chigger) feeding on humans,imago,larva,rat,pupa
3、,naiad,imago,ovum,larva,rat,pupa,naiad,第一代,第二代,(遗传、传染),The life cycle of mite,bite,ovum,Epidemiology,Proliferate in warm, wet environments Both a vector and a reservoir Route of transmission: bite of chigger Susceptibility: universal Immunity: long-lasting immunity against the homologous strains; Pa
4、rtial immunity against the other heterologous strains,Epidemiology, Other epidemiological features: Geographic distribution:Asian-pacific region Sporadic Seasonal distribution: rainy seasonsbetween May and November,Pathogenesis,human body,rickettsemia,eschar,local site,rickettsia,mite,vasculitis,rat
5、s,Pathology Basic lesion: inflammation of the walls of the small blood vessels Pathologic findings:eschar, lymphadenopathy, rash, enlargement of spleen and liver Serious pathologic manifestations:myocarditis, meningoencephalitis, pneumonia, interstitial nephritis,Clinical manifestations Incubation p
6、eriod: 421 days Sudden onset, High fever: remittent fever accompanied by chill, headache, malaise, prostration, poor appetite.,Clinical manifestations Signs of multiorgan damage: Meningoencephalitis: delirium, convulsion, coma, and neck stiffness.Interstitial pneumonia: cough, chest pain, breathless
7、ness.,Clinical manifestations Signs of multiorgan damage: Myocarditis: gallop rhythm, poor quality heart sounds, systolic murmurs.Hepatitis: jaundice, hemorrhage. Natural course: 23 weeks.,Characteristic manifestations Eschar and ulceration: Characteristic sign. Seen in 36.998 of patients. Generally
8、 located in warm, wet, intense smelled areas.,eschar,eschar,ulceration,Characteristic manifestations2. Lymphadenopathy: Enlarged markedly regional lymph nodes near the eschar. Generalized lymphadenopathy. Painful, movable, not purulent.,Characteristic manifestations3. Rash: Appears on the 4th to the
9、 6th day. Beginning on the trunk, spread to the extremities. Maculopapular, congestive, no itching. Lasting 37 days. Seen in 35100 of patients.,Characteristic manifestations4. Splenomegaly and hepatomegalySplenomegaly : 3050 of patients.Hepatomegaly: 1020 of patients.,Complications Pneumonia, myocar
10、ditis, hepatitis, DIC.,Diagnosis, Epidemiologic dataHistory of exposure to endemic areas.Rainy season.,Diagnosis,2. Clinical features Abrupt onset of fever. Accompanied with chill, lymphadenopathy, rash, enlargement of spleen and liver. Most characteristic sign: eschar. Therapeutic diagnosis.,Diagno
11、sis,3. Lab findingsA. Routine lab data: WBC liver enzyme values proteinuria.B. Serological tests Weil-Felix reaction,Diagnosis, Weil-Felix reaction: Positive result obtained from the 4th day. Higher than 1:160 is suggestive. Available and inexpensive. About 50 of patients have diagnostic titers.,Dia
12、gnosis, Complement fixation test and indirect immunofluorescent antibody test: More sensitive and specific than Weil- Felix reaction. Fourfold or greater increase in convalescence. Rarely used because of the difficult in preparing antigens.,Diagnosis,C. Isolation of organismBlood inoculating into mi
13、ce.Organism found in mononuclear cells.Specific test to confirm the diagnosis.Cant give a rapid diagnosis.,Diagnosis,D. Molecular biologic assaysNucleic acid hybridization and PCR.Great potential for sensitive and specific detection of nucleic acid.Being evaluated.Limitation of technique and facilit
14、ies conditions.,Differential Diagnosis,Other rickettsial diseases, typhoid fever, leptospirosis, malaria, dengue, septicemia, influenza PrognosisFatality rate: 960 without treatment. 5 effective treatment.,Treatment,Chloramphenicol, tetracycline, doxycyclineChloramphenicol: 1.52g daily, divided into
15、 34 aliquots.Fever abates within 48 hours.Total course: 1014 days.Side effects: suppression of bone marrow and aplastic anemia.,Prevention, Exterminating the source of infection. Reducing and controlling the vectors. Individual protection: Avoiding contact with mites: the best method.,Cysticercosis
16、（囊尾蚴病）, Definition and introduction One of parasitic diseases. Caused by the infection with the tissue larvae of Taenia solium. Acquired by ingestion of Taenia solium eggs in contaminated foods. Humans: definite host and intermediate host.,Definition and Introduction,Human infected with Taenia soliu
17、m in two forms: intestinal Taenia solium and cysticercosis. Cysticercosis has greater clinical significance. Cysticercosis: human tissue infection with theintermediate cyst forms of pork tapeworm. Cysticercus located in the subcutaneous tissue, muscle, brain.,Etiology and Pathogenesis,Taenia solium
18、eggs passed out from patients. Eggs taken in by the fecal-oral route. Eggs digested by gastric juice to liberate oncosphere. Oncosphere penetrates the intestinal wall into blood circulation.Located in subcutaneous tissue, muscle, brain.Scolex appears and develops into cysticercus.,Etiology and Patho
19、genesis,Cysticercus:Bladder-like, fluid-filled cyst.Containing an invaginated scolex. Surrounded by fibrous capsule. Multiple, 0.52cm in size.,Etiology and Pathogenesis,Cysticercus: Location in subcutaneous tissue and skeletal muscle to produce minimal, if any, symptoms; Location in brain to have se
20、rious effects; Location in substantial to be able to occupy the space to produce the relevant sign; Location in ventriculi to produce cysticercus racemosus.,Epidemiology,Geographic distribution: Latin America, East Europe, southeast Asia, Africa. Source of infection: patient. Transmission: fecal-ora
21、l route. Susceptibility: universal.,Clinical Manifestation, Depend on 2 factors:The location and number of infecting cysts; If the inflammation exists. Brain cysticercosis: found in 6092% of the total cases. Subcutaneous nodule: found in 2/3 of the total cases.,Clinical Manifestation, Brain cysticer
22、cosisThe incubation period: within 5 years. Cerebral cysticercosis Epilepsy: Caused by cysticerci located in the cortex near to the motorium.Always the first and the only symptom.,Clinical Manifestation, Epilepsy: Multifocal and unstable seizure. 2/3 of the grand mal begin with a local spasm.Petit m
23、al includes sensory and motorial obstruction.,Clinical Manifestation, Neurosis: May be the only manifestation in patients with cryptogenic cysticercosis. Intracranial hypertension symptoms: vomiting, headache, visual disturbances.,Clinical Manifestation, Ventricular cysticercosis 10 of brain cystice
24、rcosis. Caused by acute obstruction of CSF circulation. Manifest as the valve syndrome (Bruns syndrome ) with intermittent positional severe headache, vomiting, shock.,Clinical Manifestation, Subarachnoid cysticercosis 10 of brain cysticercosis. Chronic, intermittent meningitis. 3/4 have increased i
25、ntracranial pressure. Mixed formMore serious neuropsychic symptoms.,Clinical Manifestation, Ocular cysticercosis 1.8 of patients with cysticercosis. Single eye involved. Eye pain, decreasing vision, retinal detachment.,Clinical Manifestation, Subcutaneous or muscle cysticercosis 2/3 of the patients
26、have nodules. Number of nodules: 11000.More frequently felt on body and head.Generally no symptoms,Diagnosis, Definitive diagnosis: biopsy of tissue cyst. Clinical diagnosis: History of residence in an endemic area;Clinical manifestation;Plain film, CT, MRI; Suggestive laboratory finding: detection
27、of specific IgG in serum or CSF.,Treatment, Albendazole1g daily, 2 aliquots, 10 days, repeat it 2 weeks later. Praziquantel3g daily, 3 aliquots, 3 days.,Treatment,Notice when treatment: Patients should be hospitalized during the drug therapy. Epilepsy should be controlled at the same time. Increased
28、 intracranial pressure should be decreased.,Treatment,Notice when treatment: Patients with cysticercosis of the eye should not receive drug therapy until the eye disease has been controlled surgically. Surgery preferential for CSF obstruction. Serious side effects easily occurred in patients with psychiatric changes.,Prevention, Avoid consuming undercooked pork and contaminated food. Careful personal hygiene. High level of community sanitation.,
