留学生流行性乙型脑炎.ppt

留学生流行性乙型脑炎.ppt

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EpidemicencephalitisBEpidemicencephalitisBDepartmentofInfectiousDiseasesoftheSecondAffiliatedHospitalofNanchangUniversitySUNShui-linDefinitionEpidemicencephalitisBEpidemicencephalitisBAbbreviation:

Japaneseencephalitis,ItaacuteinflammatorydiseasesthatCausedbyJapaneseencephalitisvirusinbrainparenchymallesionsClinicalfeaturesAcuteonsetProtrudingheatDisturbanceofconsciousnessTwitchPathologicalreflexandmeningealirritationSeverecasesmayhaverespiratoryfailureEtiologyJapaneseencephalitisvirusisanarbovirusgroupBoftheFlaviviridae,spherical,about4050nm,thecoreisasinglestrandRNA,outsidetomembraneproteinsandoutermembraneproteinVirusresistancetoweak,exceptthelowtemperatureanddryOfhumaninfectionwiththeviruscanproducecomplementbindingantibody,neutralizingantibodyandseruminhibitionantibodyEpidemiologySourceofinfection:

humansandanimals（livestock,poultry）,especiallythepigletsarethemainsourceofinfection,humanswerenotanimportantsourceofinfectionTransmission:

themosquitoisthemajormedia,nodiseaseafterinfection,theviruscanbecarriedbythemosquitoduringwinteringandpassagedbyeggsSusceptible:

generallysusceptible,covertinfectionisthemajorspectrum,incidence:

1:

10002000,patientsweremorecommoninundertheageof10（2to6years）children,lastingimmunitySusceptible（zoonosis）EpidemiologyEpidemiologicalcharacteristics:

therearestrictseasonal,concentratedin7,8,9months（80%90%）,andstrongregional（Asia-based）PathogenesisMosquitoes（withvirus）BitesThevirusentersthehumanbodyThebreedingofmononuclearphagocytesReleasedintothebloodImmunocompetentTransientviremiapathogenremovalImmunitylowerthroughtheblood-brainbarrierencephalitisPathologicalanatomyrangeoflesions:

thebrainandspinalcordmaybeinvolved;especiallythecerebralcortex,diencephalonThenakedeye:

thebrainandthemeningesvisibleedema,congestionandhemorrhage,severelesionsmayappearmalacianecrosisPathologicalanatomyMicroscope:

Neuronpathological:

degeneration,swelling,necrosisGliacyteproliferationandcellinvasion:

Vascularpathological:

Vascularendothelialcellswelling,necrosis,lossandnecrosisofbloodvesselsaroundthebrainCerebraledemaMRIexaminationinJEpatientswithbrainparenchymallesionsshown:

abnormalsignalofthehypothalamusandbrainswellingTheglialnodulesformedinnecrosisofnervecellsanditssurroundingsmalllymphocytesinfiltrationInfiltrationoflymphocytesandmonocytesClinicalmanifestationsIncubationperiodof4to21days（10to14days）TypicalJapaneseencephalitis11、prodromalperiod（1to3days）Acutefever,Headache,nausea,vomit,neckstiffnessandconvulsionsmayhave22、periodofapparentmanifestation（410days）Themainperformanceofhighfever,disturbanceofconsciousness,convulsions,respiratoryfailureClinicalmanifestations22、periodofapparentmanifestation（410days）Highfever：

Temperature39-40,710daysorupto3weeks,withsevereheadache,Sprayingvomit。

Disturbanceofconsciousness：

Bytheirritability,drowsiness,lethargytocomagradually;earlierin1to2days,andmoreappearinthe3to8days.Mostpatientscontinuedinaweekorso,Severepatientswithupto1monthClinicalmanifestations22、periodofapparentmanifestation（410days）Twitch：

Itwaslocalorsystemicconvulsions,andmorewithdisturbanceofconsciousness,durationanddegreesvary。

Respiratoryfailure：

Themaincenterrespiratoryfailure-breathrhythmandthescopeareuneven:

asdoubleattractsandsightypebreath,thetidebreathandsoonThecircumferencerespiratoryfailure-thebreathisweaken,firstquickthenslowly,butthebreathrhythmisneatClinicalmanifestations22、periodofapparentmanifestation（410days）Nervoussystemsymptoms:

Meningealirritationpositive,Changesinpupilsizeandshape,Pathologicalreflexsignspositive,Paralysis,AutonomicdysfunctionorcranialnervedamageHighfeverTwitchRespiratoryfailureClinicalmanifestations33、RecoveryperiodManypatientsfullyrecoveredwithin2weeks,Inseverecases（5%20%）canhavemindslow,dementia,aphasia,sweating,paralysisandothersymptomsofrecovery,activetreatmentdidnotrecoverin6monthsforthesequela.44、Sequelaperiodafter6months,theexistenceofsymptoms:

dementia,aphasia,paralysisetalClinicalformBodyMindMeningealTwitchrespiratoryCourseSequelaTemperatureirritationfailureofdiseasemild3939ClearnonObvious1weektypical404040ComaObviousRepeatedly3weeksOftenfulminant4141DeepObviousContinuing3weeksisseriousDiagnosis11、EpidemiologyEndemicareas,occurredin7,8,9months;mostlyoccurredinchildrenunder10years22、ClinicalfeaturesClinicalencephalitissymptoms:

fever,headache,vomiting,unconsciousness,coma,convulsions,respiratoryfailure,meningealirritation-positive,canleadtopathologicalreflexDiagnosis33、LaboratoryBlood：

WBC:

1