chapter 15 infectious diseases
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Chapter 15 Infectious Diseases. Yang-Qiaohong. Guangzhou Universticy OF TCM. CONTENTS. TUBERCULOSIS(TB) TYPHOID FEVER BACILIARY DYSENTERY LEPROSY LEPTOSPROSIS EPIDEMIC HEMORRHAGIC FEVER SEXUALLY TRANSMITTED DISEASE. Introduction. Although the features of pathologic - PowerPoint PPT PresentationTRANSCRIPT
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Chapter 15 Infectious DiseasesChapter 15 Infectious Diseases
Yang-Qiaohong
Guangzhou Universticy OF TCM
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CONTENTSCONTENTS
• TUBERCULOSIS(TB)• TYPHOID FEVER• BACILIARY DYSENTERY• LEPROSY• LEPTOSPROSIS• EPIDEMIC HEMORRHAGIC FEVER• SEXUALLY TRANSMITTED DISEASE
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Introduction
Although the features of pathologic
change of infectious diseases is different,
its basic pathological changes is the same,
belong to the inflammation.
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肾盂肾炎志贺氏菌痢疾
疟疾斑疹伤寒
登革热病
流行性腮腺炎狂犬病
风疹麻疹水痘
雅司病
淋巴管
流感白喉
小儿麻痹症 黄热病
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TUBERCULOSIS(TB)TUBERCULOSIS(TB)
• Tuberculosis(TB) is an infectious disease caused by several different species of mycobacteria.
• The lung is his prime targetThe lung is his prime target, but any , but any
organ may be infected.organ may be infected.
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A. EtiologyA. Etiology
• Tuberculosis is caused by mycobacterium tuberculosis, which is a slender slightly curved rod-shaped aerobic bacterium. 1~4μm
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B. TransmissionB. Transmission
• The main routes of tuberculosis infection are (1) pulmonary, (2) intestinal, (3) tonsillar, (4) cutaneous, and (5) placental ( congenital ).
• The disease usually is spread by droplets from a patient with a cavitary lesion that opens into a bronchus.
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PathogenesisPathogenesis
• Five strains of mycobacterium tuberculosis are recognized ( human, bovine, murine, avian and reptilian ) and infection can occur by inhalation, ingestion (rare following testing of cattle and pasteurization) and inoculation.
• The tissue damage associated with tuberculosis is due to the specific reactivity of the immnue system occurring as a result of the presence of the bacterium.This expresses itself in two ways:
• (1) Enhanced resistance to infection and more effectivt clearing of the bacterium.
• (2) Appearance of hypersensitivity causing most of the damage.
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2. Pathogenic substance of 2. Pathogenic substance of mycobacterium tuberculosis mycobacterium tuberculosis
① Lipid: ⅰ Related to pathogenicity, especially glycolipidRelated to pathogenicity, especially glycolipid
cord factor:
wax D: cause severe allergy→ tissue damage
destroy the membrane of mitochondria inhibit the emigration of leukocyte related to the formation of granuloma
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ⅱ ⅱ Protect bacillary bodies from Protect bacillary bodies from digestion of macrophagedigestion of macrophage
inhibit bacteria combine with lysosome, the bacteria can survive
ⅲ ⅲ PhosphatidePhosphatide change the macrophage into epithelioid cells in the inflammatory focus
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② Polysaccharide lipoarabinomannan
inhibit activity of macrophage
secreting TNF-α: necrosis
IL-10: inhibit cell
immune
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③ Protein:Heat-shock protein
Ag autoinmmune reaction
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Pathogenesis Cell immunity
Type hypersensitivityⅣ
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Three consideration are involved in the pathogenesis of TB(1) Quantity of bacteria(2) Virulence of pathogen(3) Responsiveness of the body sensitivity and immune response
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Basic pathological changesBasic pathological changes
reactivity quantityvirulencefeatures of tissue
difference difference lesionslesions
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Basic pathological changesBasic pathological changes • 2. Proliferative changes• (1) Conditions• early stage immunity↓quantity↑ virulence↑ • severe hypersensitivity• (2) Pathologic changes• serous or serofibrinous • early :neutrophils• late :macrophages• (3) Site • lung, serosa, synovialis, meninges• (4) Result absorbed completely development proliferation necrosis
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Basic pathological changesBasic pathological changes • 1. Exudative changes
characteristic lesion→tubercleFormation of tubercle possesses certain diagnostic feature
• (1) Conditions• early stage • immunity↓quantity↑virulence↑ • severe hypersensitivity• (2) Pathologic changes• quantity↓ virulence↓ strong immune reaction
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Basic pathological changesBasic pathological changes ① Gross
the size of a millet clear edge grayish , semitransparent yellow with necrosis, somewhat rise on the surface of organ
② LM: typical lesion→tubercle ( formation based on cell immune ) Center: caseous necrosis Surrounding epithelioid cell Langhans giant cell Outside lymphocyte fibroblast
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Basic pathological changesBasic pathological changes ① Gross
the size of a millet clear edge grayish , semitransparent yellow with necrosis, somewhat rise on the surface of organ
② LM: typical lesion→tubercle ( formation based on cell immune ) Center: caseous necrosis Surrounding epithelioid cell Langhans giant cell Outside lymphocyte fibroblast
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Basic pathological changesBasic pathological changes ⅰ Epithelioid cell Source: macrophage phagocytize→M.tuberculosis Shape: large, abundant cytoplasm, pseudopod Function: phagocytize, kill mycobacterium
ⅱ Langhans giant cell Source fusion of epithelioid cells division of nuclei without cytoplastic division Shape: multinuclei, floral hoop or horseshoe-like Function: phagocytizing and killing mycobacterium
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Langhans giant cell
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Epithelioid cell
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Basic pathological changesBasic pathological changes 3. Alterative changes (1) Conditions: quantity↑ virulence↑resistence↓ severe allergy (2) Lesion: feature→caseous necrosis ① ① GrossGross: slight yellow, homogenous, exquisite creamy ② ② LM:LM: red staining, no structure, granular substance (3) Result uneasily absorbed not autolysis, excluded sometimes: softed, liquefy→spread
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Basic pathological changesBasic pathological changes
Three lesions can exist simultaneously transform one another
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BACILLARY DYSENSES
• Bacillary dysentery is an acute infectious inflammatory disease of the colon,occasionally involving the ileum as well,caused by microorganisms of the genus shigella