感染性疾病病毒感染麻疹

1、3/28/2024,麻疹,1,第十章感染性疾病病毒感染--麻　疹,Measles,蚌埠醫(yī)學(xué)院附屬醫(yī)院兒科 董淮富,3/28/2024,麻疹,2,目的要求,熟悉麻疹的病因、流行病學(xué)及發(fā)病機(jī)制掌握麻疹早期診斷要點(diǎn)及典型臨床經(jīng)過熟悉其它類型麻疹的臨床表現(xiàn)熟悉麻疹常見并發(fā)癥掌握麻疹與其它發(fā)疹性傳染病的鑒別要點(diǎn)掌握麻疹的防治原則及方法,3/28/2024,麻疹,3,概　述(overview),麻疹是一種由麻疹病毒引起的急性呼吸道傳

2、染病(Measles is an acute respiratory contagious disease caused by measles virus ),3/28/2024,麻疹,4,概　述(overview),臨床特征為：發(fā)熱、上呼吸道炎癥、結(jié)合膜炎、Koplik斑及全身性斑丘疹(clinical features: fever,upper respiratory inflammation, conjunctivitis, Ko

3、plik’s spots and generalized maculopapular rash),3/28/2024,麻疹,5,病　原(ETIOLOGY),麻疹病毒(measles virus)屬副粘液病毒，無亞型，僅一種抗原型( RNA-containing virus of the Paramyxovirus family ,only one serotype),3/28/2024,麻疹,6,病　原(ETIOLOGY)

4、,麻疹病毒(measles virus)麻疹病毒不耐熱，對日光和消毒劑均敏感，但在低溫中能長期保存(Measles virus are rapidly inactivated by heat,light , and all kinds of desinfectant,but can be stored indefinitely at low temperature)。,3/28/2024,麻疹,7,病　原(ETIOLOGY),麻疹病毒

5、(measles virus)存在于患者前驅(qū)期和出疹期的眼結(jié)膜、鼻、咽、氣管等分泌物中(During the prodromal period and eruption period,it is found in sections of conjunctiva, nose , pharynx ,trachea and so on)。,3/28/2024,麻疹,8,麻疹的發(fā)病機(jī)制,鼻、咽 短期繁殖病毒

6、 局部粘膜 血流 遠(yuǎn)處器官單核 眼結(jié)膜 （第一次） 巨噬細(xì)胞系統(tǒng) 潛伏期大量繁殖 局部癥狀 　 血流 　　　　 （第二次） 前驅(qū)期 全身癥狀,,,,,,,,,3/28/2024,麻疹,9,病理(PATHOGEY),全身淋

7、巴組織增生，有多核巨細(xì)胞形成 (Hyperplasia of all lymphoid tissue usually occurs,multinucleated giant cells may be found ),3/28/2024,麻疹,10,病理(PATHOGEY),多核巨細(xì)胞(multinucleated giant cells)：多個巨噬細(xì)胞融合形成的具有核內(nèi)外包涵體的巨細(xì)胞網(wǎng)狀內(nèi)皮巨細(xì)胞也稱華-佛細(xì)

8、胞（reticuloendothelial giant cells or Warthin-Finkeldey cells)：存在于全身淋巴組織和肝、脾等臟器中上皮巨細(xì)胞（epithelial giant cells）：主要位于皮膚、眼結(jié)合膜、呼吸道和消化道粘膜等處,3/28/2024,麻疹,11,病理(PATHOGEY),皮膚、眼結(jié)合膜、鼻咽部、支氣管、腸道粘膜等處可見單核細(xì)胞增生及圍繞在毛細(xì)血管周圍的多核巨細(xì)胞，淋巴樣組織肥大(Pr

9、olifieration of mononuclear cells is found in the skin,in the conjunctivae and in the mucous membranes of the nasopharynx, bronchi, and intestinal tract,multinucleated giant cells occur around the capillaries. Hyperp

10、lasia of lymphoid tissue occurs.),3/28/2024,麻疹,12,病理(PATHOGEY),頰粘膜下層的微小分泌腺發(fā)炎，其病變內(nèi)有漿液滲出及內(nèi)皮細(xì)胞增殖形成Koplik斑 (An inflammatory reaction occurs in the fine secretor of the buccal mucosa, where serous exudate and proliferation

11、of endothelial cells result in Koplik’s spots),3/28/2024,麻疹,13,病理(PATHOGEY),麻疹引起的間質(zhì)性肺炎為Hecht巨細(xì)胞肺炎 (Interstitial pneumonitis resulting from measles virus takes the form of Hecht giant cell pneumonia),3/28/2024,麻疹,14,病理

12、(PATHOGEY),麻疹皮疹的病理改變：真皮毛細(xì)血管內(nèi)皮增生、血漿滲出、紅細(xì)胞相對增多形成淡紅色斑丘疹(Maculopapular rash consists of proliferation of capillary endothelial cells in skin,serous exudate and relative increase of red cells)疹退后，表皮細(xì)胞壞死、角化形成脫屑。皮疹處紅細(xì)胞裂解，疹退后形

13、成棕色色素沉著。,3/28/2024,麻疹,15,典型麻疹(Typical measles),潛伏期(Incubation stage)一般為10~14天(亦可短至1周)，此期可有輕度體溫上升(It lasts usually 10~14 days after contact,maybe as short as 1 week.The temperature may increased slightly)。,臨床表現(xiàn),3/28/2024

14、,麻疹,16,典型麻疹,前驅(qū)期 (Prodromal stage)　指從發(fā)熱至出疹,一般為3-4天(from fever to rash appearance,usually lasts 3-4 days),臨床表現(xiàn),3/28/2024,麻疹,17,典型麻疹,主要表現(xiàn)：發(fā)熱、上呼吸道炎癥、眼結(jié)合膜炎、Stimson線(fever,upper respiratory inflammation, conjunctivitis ) 麻疹粘膜

15、斑(Koplik’s spots),前驅(qū)期 (Prodromal stage),臨床表現(xiàn),3/28/2024,麻疹,18,Koplik’s spots(麻疹粘膜斑),時間：發(fā)疹前24 —48小時出現(xiàn)(24-48 hours before the appearance of the rash)；位置：開始對著下臼齒的頰粘膜上；以后累及整個頰部并蔓延至唇部粘膜(initially opposite the lower molars

16、but may spread the rest of the buccal and lip mucosa)。,臨床表現(xiàn),3/28/2024,麻疹,19,Koplik’s spots(麻疹粘膜斑),形態(tài)：直徑約1㎜的灰白色小點(diǎn)，外有紅暈(grayish white dots with 1mm in diameter,usually as small as grains of sand,that reddish areolae)；

17、發(fā)展：1天內(nèi)很快增多，皮疹出現(xiàn)后逐漸消失(They spread rapidly within one day and disappear gradually after the appearance of the rash)。,臨床表現(xiàn),3/28/2024,麻疹,20,3/28/2024,麻疹,21,典型麻疹,出疹期 (eruption stage) 在發(fā)熱3-5天后出現(xiàn),持續(xù)3-5天 出疹順序:耳后、發(fā)際→額、面部

18、→頸→軀干→四肢,達(dá)手掌、足底 (initially occurring behind the ears and hairline and spreading down from the forehead and face to neck ,the trunk and the extremities).,,臨床表現(xiàn),3/28/2024,麻疹,22,典型麻疹,出疹期 (eruption stage)皮疹性質(zhì):紅色斑丘疹，疹間皮

19、膚正常(red maculupapular rash, there is normal skin among rashes.),臨床表現(xiàn),3/28/2024,麻疹,23,,3/28/2024,麻疹,24,典型麻疹,恢復(fù)期　(convalescent period) 皮疹按出疹先后順序消退,伴有糠麩樣脫屑及棕色色素沉著,經(jīng)7~10天消失(The rash fades downward in the same sequence in w

20、hich it appeared .As the rash fades , branny desquamation and brownish discoloration occur and then disappear within 7-10 days),臨床表現(xiàn),,3/28/2024,麻疹,25,并發(fā)癥(complications),肺炎(pneumonia) 是麻疹常見的并發(fā)癥，多見于出疹期，繼發(fā)細(xì)菌或其它病毒感染喉、氣

21、管、支氣管炎(laryngitis,trachitis, bronchitis)心肌炎(myocarditis),,,3/28/2024,麻疹,26,并發(fā)癥(complications),麻疹腦炎及亞急性硬化性全腦炎（measles encephalitis and subacute sclerosing panencephalitis 簡稱SSPE)結(jié)核病惡化(tuberculosis exacerbating)營養(yǎng)障礙與維生素

22、A缺乏癥(malnutrition and vitamin A deficiency),3/28/2024,麻疹,27,診 斷(DIAGNOSIS),麻疹接觸史(exposure to measles previously)典型臨床表現(xiàn)(typical clinical manifestations),3/28/2024,麻疹,28,診 斷(DIAGNOSIS),前驅(qū)期鼻咽部找多核巨細(xì)胞及尿中檢測包涵體細(xì)胞(During the

23、prodromal stage, multinucleated giant cells are found in nasopharynx,intrancuclear and intracytoplasmic inclusion bodies cells are found in urine),3/28/2024,麻疹,29,診 斷(DIAGNOSIS),ELISA法檢測麻疹抗體(Measles virus antibodies b

24、ecome detectable by ELISA when the rash ppears;testing of acute and convalescent sera shows the diagnostic seroconversion or fourfold increase in titer),3/28/2024,麻疹,30,鑒別診斷,3/28/2024,麻疹,31,麻疹的流行病學(xué)及預(yù)防,,,3/28/2024,麻疹,32,

25、麻疹的流行病學(xué)及預(yù)防,流行病學(xué) 傳播途徑：　　 主要是呼吸道飛沫傳播。,預(yù)　防 切斷傳播途徑：　　實(shí)行“三門”，病人住所、衣物按規(guī)定消毒。,,,3/28/2024,麻疹,33,麻疹的流行病學(xué)及預(yù)防,流行病學(xué),預(yù)　防　　　保護(hù)易感人群：　主動免疫(active immunization)，　被動免疫(passive immunization)。,易感性: 人類對麻疹病毒普遍易感。易感者： 未曾患過麻疹或未接

26、種過麻疹疫苗者。,,,3/28/2024,麻疹,34,治 療(TREATMENT),無特異抗病毒治療，只有支持治療和對癥治療。(There is no specific antiviral therapy ;treatment is entirely supportive and symptomatic treatment),3/28/2024,麻疹,35,治 療,一般治療 給予易消化的富有營養(yǎng)的食物

27、，補(bǔ)充充足水分；保持皮膚、粘膜清潔,3/28/2024,麻疹,36,治 療,一般治療 臥床休息，房內(nèi)保持適當(dāng)?shù)臏囟群蜐穸龋形饭獍Y狀時房內(nèi)光線要柔和 (bed rest , keeping comfortably humidification and warm of the room ;patients with photophobia should be protected from exposure to strong l

28、ight)。,3/28/2024,麻疹,37,治 療,對癥治療 高熱時可用小量退熱劑。慎用退熱藥，煩躁者鎮(zhèn)靜。劇咳時鎮(zhèn)咳祛痰。繼發(fā)細(xì)菌感染可給抗生素，補(bǔ)充維生素A。,3/28/2024,麻疹,38,麻疹的新進(jìn)展,麻疹的發(fā)病年齡呈兩極分化趨勢嬰兒麻疹增多，主要發(fā)生在8個月以前,多為非典型病例；大年齡患者增多。 麻疹的不典型病例增多。 發(fā)病高峰季節(jié)后移至3-5月份,3/28/2024,麻疹,39,麻疹的并發(fā)癥的變化： 心肌炎

29、明顯增多，且年齡越小，發(fā)病率越高。二次麻疹發(fā)生率: 在1%左右，其中60%發(fā)生在第一次麻疹二年以內(nèi)。雖然麻疹病例增多，但病死率卻很低。,麻疹的新進(jìn)展,,3/28/2024,麻疹,40,麻疹前驅(qū)期最有診斷價值的表現(xiàn) ( ) A 發(fā)熱3-5天 B 有卡他癥狀 C Koplik’s spots D 可見少數(shù)斑丘疹E 有麻疹接觸史,,麻疹提

30、問1,3/28/2024,麻疹,41,麻疹提問2,麻疹最常見的并發(fā)癥是： A 支氣管肺炎 B 心肌炎 C 喉炎 D 腦炎和亞急性硬發(fā)性全腦炎 E 結(jié)核病惡化,3/28/2024,麻疹,42,麻疹提問3,6個月嬰兒,突然體溫升高達(dá)39.5°以上已2天,一般情況良好,除輕微咽充血及頸、枕后淋巴結(jié)腫大外,未見其它異常.下列各項(xiàng)中最有可能的是( ) A 如果繼續(xù)發(fā)熱