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1、Tuberculosis結(jié)核病Dr.HeQing-Nan（何慶南）第十章第三節(jié)中南大學(xué)兒科學(xué)教研室IntheworldTBkills2millionpeopleeachyearAbout8millionpeoplebecomesickwithTBeachyearBetween2001and2020,nearlyonebillionpeoplewillbenewlyinfected,200millionpeoplewillgetsick,35millionpeoplewilldiefromTB--Ifpresenttrends
2、continue.-----WHOIntroductionOnethirdofworld’spopulation,2billionpeople,areinfectedwithM.Tuberculosis.TBInfectionratesarehighestinSoutheastAsia,China,India,Africa,andLatinAmerica.------------16thNelsonTextbookofPediatricsIntroductionInChinaMorethan330millionpeoplei
3、nfectedwithTBMorethan6millionpeoplebecomesickwithTBTBinfectionrateinchildrenis9.6%Introduction▲▲▲March24WorldTBDay世界結(jié)核病日IntroductionWorldTBDay 24March2001"DOTS-TBcureforAll""DOTS:untraitementantituberculeuxpourtous"StopTB,FightPoverty.WorldTBDay2002WorldTBDay,March
4、24,2004TBisachroniccontagiousdisease,causedbytuberclebacilli.PrimarypulmonarytuberculosisisthemostcaseofTBinchildren.DefinitionEtiology病因Mycobacteriumtuberculosis/結(jié)核桿菌Acid-Fastbacillus,AFB(RobertKoch,1882)抗酸染色為紅色---抗酸桿菌M.tuberculosis(人型結(jié)核桿菌)&M.bovis（牛型結(jié)核桿菌）aretwoma
5、inspeciescausingtuberculosisinhuman.TransmissionTBcandevelopafterinhalingdropletssprayedintotheairfromacoughorsneezebysomeoneinfectedwithM.tuberculosis.(主要傳播途徑為呼吸道)Transmissionthroughgastrointestinaltractanddirectskincontactisuncommon.（經(jīng)消化道、皮膚和胎盤少見）Infants&children
6、aremostfrequentlyinfectedbyanadultmemberwhoisanopenactiveTBpatientofthehousehold.常見的傳播源為家庭成員、密切接觸的親屬、保姆、鄰居，尤其是哺乳期母親患開放型肺結(jié)核。TransmissionanopenactiveTBpatientTransmissionPathogenesis發(fā)病機(jī)制Acid-Fastbacillus進(jìn)入體內(nèi)（胞內(nèi)寄生）致敏T淋巴細(xì)胞（細(xì)胞免疫，4~8周）釋放cytokines/lymphokines激活macrophages
7、吞噬和殺滅結(jié)核桿菌PathogenesisImmunityResponseAllergy同一細(xì)胞免疫免疫過程中的兩種不同表現(xiàn)PathogenesisInheritancefactorsPathogenesisDiagnosis診斷DiagnosisSex:female＞maleAge:＜5yrsDiagnosis-----CaseHistoryToxicsymptomsoftuberculousinfection/結(jié)核中毒癥狀Historyofcontactwithpulmonarypatients/結(jié)核接觸史History
8、ofBCGvaccination/卡介苗接種史Historyofotherinfectionillness/既往病史Toxicsymptomsoftuberculousinfectionmildfever/低熱nightsweat/盜汗fatigue/乏力poorappetite/食欲減退
