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1、1,Prof. Qin Ning (宁琴), MD. PHD Department of Infectious Disease, Tongji Hospital,Introduction to Infectious Diseases,TONGJI MEDICAL COLLEGE HUAZHONG UNIVERSITY OF SCIENCE & TECHNOLOGY,2,What is an Infectious Disease?,Infectious Diseases - caused by human infection of micro-organisms and parasites In
2、fection - the ability of an organism to invade and establish itself in a hostCommunicable Infection - a disease that is transmitted from person to another,3,What is an Infectious Disease?,MicroorganismsBacteriaVirusPrion(盶毒体)FungusProtozoa (原虫)Helminth (蠕虫)Products from microorganismstoxins,4,Curren
3、t Situation,Increasingly serious threats from Communicable diseases Re-emerging: TB(结核), STD, plague(瘟疫), cholera(霍乱) Emerging: AIDS, SARS,5,6,The Incidence Rate of Communicable Diseases in China,Current Situation,7,The Proportion of Different Communicable Diseases by Etiology in China, 1950s-2002s,
4、Transmitted by sex or blood,Gastrointestinal,Vector-borne and natural endemic,Respiratory,8,Leading Causes of Death,9,10,Reemerging Infectious Disease,Why?Human Demography and BehaviorTechnology and IndustryEconomic development and Land UseMicrobial Adaptation and ChangeBreakdown of Public Health Me
5、asuresand Deficiencies in Public Health,11,Natural Environment Destroy,12,Infection and Immunity,infection,immunity,Disease =,13,Response to Infection,adaptive immunity,14,Infection spectrumPrimary InfectionRepeated InfectionMixed InfectionSuperinfectionSecondary Infection,15,Infection,Pathogen erad
6、ication,Overt infectionClinical Infection,Latent infection,Pathogen eradication,Carrier,Patient,Colonization,Carrier,Covert infectionSubclinical infection,Bacteremia/viremia,Clinical Outcomes of Infection,16,Pathogenic effectiveness of micro-organisms,Pathogenecity,Invasiveness (colonization factor)
7、,Virulence (exotoxin and endotoxin),Quantity,Variability (HBV mutation),17,Immunity,Nonspecificimmunity,Specificimmunity,Natural barrier,Phagocytosis,Humoral factor,Cellular immunity,complement,cytokine,lysozyme,Humoral immunity,IgM,IgA,IgE,IgG,Immune Response in Infection Process,18,Cells of the Im
8、mune System,Leukocytes (Not Ag specific)neutrophils (PMNs)monocyte/macrophageeosinophilbasophilSpecialized cells (Ag specific)B-cells antibodiesT-cells,19,T cells classification,20,How does the immune system work?,MHC class I molecule presenting an epitope,21,Infection and Immune,22,Infection and Im
9、mune(herpes simplex),Initial infection by herpes simplex virus in the skin is cleared by an effective immune response. But residual infection persists in sensory neurons. When the virus is reactivated, the skin is re-infected. This can be repeated endlessly.,23,Pathogenesis of Infectious Disease,24,
10、Direct Injury ToxinHarmful Immune response,Invasion,Colonization,Output,Pathogen,Injury,FeverMetabolism disorderEndocrine disturbance,Development of infectious disease,Injury of cells and tissues,Disorder of pathophysiology,25,AdhesinsCapsular materialProteins (Protein F, Protein M)Lipotechoic acids
11、Fimbriae & PiliEndotoxinsGram negative LPS cell wall components (Lipid A and Core Sugars) ExotoxinsCan be produced by either Gram Positive or Gram Negative Organisms,Cell and Tissue Damage Induced by Micro-organisms Bacteria,26,Cell and Tissue Damage Induced by Micro-organisms viruses,Direct attachm
12、ent and killingInhibit host cell synthesis (RNA, DNA, proteins)Intracellular replication and lysisSurface targets for host immune systemLocal direct damage leading to secondary bacterial infectionsLatent injury,27,Harmful Host Responses to Infectious Agents,Autoimmunity: break the rules of the “self
13、-versus-nonself”. Direct against “self-proteins”Hypersensitivity reactions type I or immediate hypersensitivity (mast cell associated IgE) type II or cytotoxic hypersensitivity (antibody-complement activation and natural killer) type III or immune-complex-mediated hypersensitivity type IV or delayed
14、-type hypersensitivity (activated T, CD8+, Mac) prolonged antigen exposure,28,Enterovirus Pathogeneis,29,Colonized herd,30,Epidemic Process,31,Epidemic Process,Source of infection,Route of transmission,Susceptible population,32,Why do people get sick?,New pathogens or changes in pathogens (HIV, Nile
15、-like virus)Changes in environmental conditions(natural or man-made)Host Factors(Age, gender, ethnicity, immune status,Nutritional status, behavior),33,Source of Infection,PatientCovert infected personCarrierInfected animal,34,Other effective factors:,Climate Temperature, HumiditySociety Sanitation,
16、 Cultural Background, War,35,Routes of Transmission,Air-borne, droplet infection,dustFomite borne (污染物): Water, food, fliesDirect contact of unclean hands and fingers, toysVector borne A) mechanical B) biological Blood and blood source productsContact with soilTransplacental,36,HIVs Transmission Rou
17、tes,37,Susceptible Population,A group of people at increased risk for infection and illness from a pathogen, often caused by a decrease in the effectiveness of the persons immune system.,38,Chain of Transmission,Portal of exit,Portal of entry,Agent,Susceptible Host,Mode of transmission,Reservoir,Per
18、son to person transmission,39,Agent,Host,Environment,Age Sex Genotype Behaviour Nutritional status Health status,Infectivity Pathogenicity Virulence Immunogenicity Antigenic stability Survival,Weather Housing Geography Occupational setting Air quality Food,Factors Influencing Disease Transmission,40
19、,Distribution due to Socioeconomic,Hepatitis ATyphoid feverHelicobacter pyloriOther bacterial diarrheasTuberculosis,41,Characteristics of Infectious Diseases,42,PathogenInfectivity: isolation of patientsEpidemiologic feature: continue with next slidePost-infection immunity,Basic features,43,Level of
20、 Epidemic,Sporadic level - occasional cases occurring at irregular intervals Endemic level - persistent occurrence with a low to moderate level Hyperendemic level - persistently high level of occurrenceEpidemic or outbreak - occurrence clearly in excess of the expected level for a given time periodP
21、andemic - epidemic spread over several countries or continents, affecting a large number of people,44,Clinical Phage,Incubation period (潜伏期)Prodromal period (前驱期)Manifestation period (症状期)Recovery phase (恢复期)Relapse (复发): fully recover and disease re-appearesRecrudescence (再燃): not fully recovered a
22、nd got worserSequela (后遗症): functionally not fully recovered,45,1. Effervescence (increasing) 2. Fastigium (peaking) 3. Defervescence (decreasing),Symptoms and signs,Fever Process,46,Symptoms and signs,Fever types,Sustained Fever,Remittent Fever,Intermittent Fever (septic fever),Relapsing Fever (Und
23、ulant Fever),Saddle Type Fever,Irregular Fever,47,Fever type,Sustained Fever,Remittent Fever,Intermittent Fever (septic fever),Undulant Fever,Relapsing Fever,Irregular Fever,48,Skin Eruption,Macule(班疹),Maculo-papule(班丘疹),Roseola(玫瑰疹),49,Skin Eruption,Petechiae(出血疹),Ecchymosis,Herpes,50,The Time Rash
24、 Appears,Day 1 Rubella (风疹) Day 2 Scarlet Fever (猩红热) Day 3 Small Pox (天花) Day 5 Typhus Fever (班疹伤寒) Day 6 Typhoid (伤寒),51,Other Symptoms,Conjunctiva congested,Enlargement of lymph nodes,Toxemic symptoms Bleeding Coma Mononuclear-phagocyte system response Spleno-hepatomegaly,52,Diagnosis,Epidemiolog
25、y vital and significant in diagnosis Clinical Manifestation such as rose rash, splenohepatomegaly, gastrocnemius tenderness Laboratory Test main means for diagnosis,53,Laboratory Test,Light Microscopy H & E stained sections Special Stains: Gram, Acid Fast, Giemsa Culture Bacterial, Mycobacterial, Fu
26、ngal, Viral Immune Test Serologic Studies ELISA Immunoperoxidase Stains Direct Fluorescent Antibodies Polymerase Chain Reaction,54,Treatment,General and supporting treatmentHeteropathy (对症治疗)Pathogenic and specific treatmentRehabilitation therapyTraditional Chinese Medicine and acupuncture treatment
27、,55,Antibiotic Therapy,Proper doseProper time intervalProper route of administration (oral, parenteral)Combination antibiotic therapy,56,The main classes of antibiotics,Aminoglycosides Cephalosporins Fluoroquinolones Macrolides Penicillins Tetracyclines,57,Antibiotic Resistance,58,Antiviral Therapy,
28、InterferonNucleoside AnaloguesHigh Active Anti-Retroviral Therapy, HAART Treat HIV,HBV,HCV,Interferon,Lamivudine,59,Antiparasitic Drugs,Antimalarial (抗疟药) CHLOROQUINE(氯喹)Antiprotozoal Drugs (抗原虫药)Amebiasis(阿米巴病)and Trichomonas(毛滴虫属) METRONIDAZOLE(甲硝唑)Fluke(吸虫) and Tapeworm(绦虫) InfectionsSchistosomia
29、sis(血吸虫病) PRAZIQUANTEL(吡喹酮)Filariasis(丝虫病) diethylcarbamazine(乙胺嗪)Intestinal Roundworms (Ascaris),(线虫,蛔虫) Enterobius (Pinworm)(蛲虫) and Hookworm(钩虫) Albendazole(丙硫咪唑),60,Prophylaxis,Sanitationwater and waste treatmentpersonal hygieneVaccinationprobably the best way to prevent communicable diseasesHea
30、lthy living practice safe sexavoid drugsAntibiotics and other drugs,61,Prophylaxis,62,Law of the peoples Republic of China on Prevention and Treatment of Infections Diseases,Article 3 The infectious diseases governed by this Law are divided into Classes A， B and C. Infectious diseases under Class A
31、are plague and cholera.,63,Law of the peoples Republic of China on Prevention and Treatment of Infections Diseases,Infectious diseases under Class B are infectious SARS， AIDS， viral hepatitis, poliomyelitis， highly pathogenic avian influenza， measles， epidemic hemorrhagic fever， rabies epidemic ence
32、phalitis B， dengue fever， anthrax， bacillary and amebic dysentery， pulmonary tuberculosis， typhoid and paratyphoid， epidemic cerebrospinal meningitis， pertussis， diphtheria， tetanus infantum， scarlet fever， brucellosis， gonorrhoea， syphilis， leptospirosis， schistosomiasis and malaria.,64,Law of the
33、peoples Republic of China on Prevention and Treatment of Infections Diseases,Infectious diseases under Class C are influenza， epidemic parotitis， rubella， acute hemorrhagic conjunctivitis， leprosy epidemic and endemic typhus， kala-azar， echinococcosis， filariasis， and infectious diarrhea other than
34、cholera， bacillary and amebic dysentery， typhoid and paratyphoid.,65,Law of the peoples Republic of China on Prevention and Treatment of Infections Diseases,Article 30 When disease prevention and control institutions， medical agencies， blood collectors and supplies or their staff members on duty fin
35、d the epidemic situation of infectious diseases or the this Law or the outbreak and prevalence of other infectious diseases or the infectious diseases the causes for the sudden outbreak of which are uncertain， they shall report in adherence to the principle of territorial control in respect of repor
36、t on epidemic situation and in accordance with the contents， procedure， from and time limit prescribed by the State Council or by the health administration department under the State Council.,66,Brief Review,What is an Infectious Disease?Current SituationPathogenesisEpidemiologyClinical Manifestatio
37、nDiagnosisTreatment,67,Perferences,Paul D. Hoeprich, M.colin Jordan, Allan R. Ronald Infectious Diseases . J.B. Lippincoott Company. Philadelphia 1994.Vallejo M, Molina A, Mosquera J, et al . Early Hospital Mortality due to infectious diseases. An Med Interna. 2003 Jul;20(7):347-350. Tarasevich IV,
38、Shaginyan IA, Mediannikov OY. Problems and perspectives of molecular epidemiology of infectious diseases. Ann N Y Acad Sci. 2003 Jun;990:751-6. Cornelis GR. Bacterial infectious diseases. A rejuvenated field. Cell. 2003 Jul 11;114(1):12-3. Mouthon L, Lortholary O. Intravenous immunoglobulins in infectious diseases: where do we stand? Clin Microbiol Infect. 2003 May;9(5):333-8. Enserink M. Infectious diseases. U.S. monkeypox outbreak traced to Wisconsin pet dealer. Science. 2003 13;300:1639.,68,973重大项目 NSFC杰出青年和青年基金 国际核心期刊论文 优秀博士生论文,韩梅芳,严伟明,习 东,69,Thanks for Your Attention!,70,