TUBERCULOSIS
Our team members 孙满意 刘婷婷 李晓露 宗广鑫 张桂 李刚 2007－11－23，CLASS FOUR
病例 大学生张某，男，20岁，因发热、咳嗽、血痰3个月入院。近3个月来有低热、午后体温增高、咳嗽，曾按感冒处理，疗效欠佳。近半月来有胸痛，咳嗽加剧，痰中带血。半年来有明显厌食，消瘦，夜间盗汗。 入院检查：T：38℃， P：88次/分， R：28次/分， 发育正常，营养稍差，消瘦，神志清楚，查体合格。胸部检查：双肺扣诊清音，胸部X线平片检查可见双肺纹理增粗，散在大小不等的结节状阴影，右肺尖有片状阴影。痰、细菌及抗酸菌检查菌阴性，PPD试验强阳性。再次取痰送检，经浓缩集菌后涂片，痰抗酸性细菌为阳性。该病人与其他三位同学同住，同住同学询问自己是否已被感染。 （3）该病例的PPD试验的结果说明了什么？ （4）该患者同宿舍的其他同学怎样才能确定有无被感染？怎样预防？
TB is an ancient infectious disease caused by Mycobacterium tuberculosis. It has been known since 1000 B.C., so it not a new disease. Since TB is a disease of respiratory transmission, optimal conditions for transmission include: overcrowding poor personal hygiene (卫生) poor public hygiene
Pathological change Tubercle Caseous necrosis Chronic granuloma
Tuberculosis 浸润型肺结核 慢性纤维空洞型肺结核 血行散播型肺结核 原发型肺结核
浸润型,内源性复燃为主 慢性纤维空洞型,纤维化,钙化,增生 血行播散型,侵蚀动静脉,毒学症 原发型,初次感染
TUBERCULOSIS PULMONAR
TUBERCULOSIS HEPÁTICA
TUBERCULOSIS RENAL
Pathogenicity Pathogenicity substance: Lipid and Protein Disease: Tuberculosis
Lipid: Phosphatide, mycolic acid(分支菌酸), cord factor ,Wax D. Protein: tuberculin, protein—Wax D can induce allergic response. Disease: Primary tuberculosis and post-primary tuberculosis.
Once inhaled by a tuberculin free person, the bacilli multiply 4 -6 weeks and spreads throughout the body. The bacilli implant in areas of high partial pressure of oxygen: lung renal cortex reticuloendothelial system
This is known as the primary infection. When a person's immune system is depressed., a secondary reactivation occurs. 85-90% of the cases seen which are of secondary reactivation type occurs in the lungs.
Diagnosis 病原学诊断（1）涂片抗酸染色镜检法 （2）培养法 （3）药敏试验 辅助性诊断（1）免疫学 （2）血清学 （3）酶学 组织学诊断（1）肺的液体活组织检查 （2）肺活组织检查 （3）胸膜活组织检查淋巴结检查 影像学诊断（1）普通X线检查 （2）CT （3）磁共振成像
Diagnosis OT( old tuberculin): TB Glycerol broth 4-8 weeks 100 ℃,1h filtration concentration(1/10) PPD (purified protein derivative): TB special media 6-8 weeks TCA precipitation
PPD injection 24-48h Induration, erthyema “-”---Ø<5mm:1) no TB infection 2) early stage of primary infection 3) serious infection of tuberculosis 4) virus infection; tumor, ADIS 5) use of immunosuppressive agents “+”---5mm<Ø<15mm: hypersensitive to M. tuberculosis; immunity “++”---Ø>15mm: active TB perhaps
Prevention Step One Wash your hands frequently, especially when you have been around people with chronic coughs. Step Two Wear a mask. A special, high-microfiltration mask will keep the TB bacilli from invading your respiratory system. Step Three Have an annual TB skin test. These are available for minimal cost at most community clinics, and at health fairs offered at shopping malls and senior centers.
Step Four Have a chest X-ray if you are sensitive to the TB skin test. An X-ray can detect clinical signs of TB in your lungs. Step Five Avoid standing too close to people when they are coughing. You can never know for sure if you are being exposed to TB, but if you stay away from the germs spewed about when people cough and sneeze, you will reduce your risk of becoming infected. Step Six Breathe in lots of fresh air. Step Seven Eat a healthy diet, rich in vitamins, minerals, calcium, protein and fiber.
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