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1、中南大学儿科教研室麻疹专题,中南大学儿科教研室麻疹专题中南大学儿科教研室麻疹专题概述(overview)临床特征为：发热、上呼吸道炎症、结合膜炎、Koplik斑与全身性斑丘疹(clinical features: fever,upper respiratory inflammation, conjunctivitis, Kopliks spots and generalized maculopapular rash) 2,通过阅读报刊，我们能增长见识，扩大自己的知识面。,中南大学儿科教研室麻疹专题中南大学儿科教研室麻疹专题中南大学,概述(overview),临床特征为：发热、上呼吸道炎症、结合
2、膜炎、Koplik斑与全身性斑丘疹(clinical features: fever,upper respiratory inflammation, conjunctivitis, Kopliks spots and generalized maculopapular rash),2,概述(overview)临床特征为：发热、上呼吸道炎症、,病原(ETIOLOGY),麻疹病毒(measles virus)属副粘液病毒，无亚型，仅一种抗原型( RNA-containing virus of the Paramyxovirus family ,only one serotype),3,病原(ETI
3、OLOGY)麻疹病毒(measles viru,病原(ETIOLOGY),麻疹病毒(measles virus)麻疹病毒不耐热，对日光和消毒剂均敏感，但在低温中能长期保存(Measles virus are rapidly inactivated by heat,light , and all kinds of desinfectant,but can be stored indefinitely at low temperature)。,4,病原(ETIOLOGY)麻疹病毒(measles viru,病原(ETIOLOGY),麻疹病毒(measles virus)存在于患者前驱期和出疹期的眼
4、结膜、鼻、咽、气管等分泌物中(During the prodromal period and eruption period,it is found in sections of conjunctiva, nose , pharynx ,trachea and so on)。,5,病原(ETIOLOGY)麻疹病毒(measles viru,麻疹的发病机制,鼻、咽 短期繁殖病毒 局部粘膜 血流 远处器官单核 眼结膜 （第一次） 巨噬细胞系统 潜伏期大量繁殖 局部症状 血流 （第二次） 前驱期 全身症状,6,麻疹的发病机制 6,病理(PATHOGEY),全身淋巴组织增生，有多核巨细胞形成 (Hyp
5、erplasia of all lymphoid tissue usually occurs,multinucleated giant cells may be found ),7,病理(PATHOGEY)7,病理(PATHOGEY),多核巨细胞(multinucleated giant cells)：多个巨噬细胞融合形成的具有核内外包涵体的巨细胞网状内皮巨细胞也称华-佛细胞（reticuloendothelial giant cells or Warthin-Finkeldey cells)：存在于全身淋巴组织和肝、脾等脏器中上皮巨细胞（epithelial giant cells）：主要位
6、于皮肤、眼结合膜、呼吸道和消化道粘膜等处,8,病理(PATHOGEY)多核巨细胞(multinucleat,病理(PATHOGEY),皮肤、眼结合膜、鼻咽部、支气管、肠道粘膜等处可见单核细胞增生与围绕在毛细血管周围的多核巨细胞，淋巴样组织肥大(Prolifieration 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 ce
7、lls occur around the capillaries. Hyperplasia of lymphoid tissue occurs.),9,病理(PATHOGEY)皮肤、眼结合膜、鼻咽部、支气管、肠道,病理(PATHOGEY),颊粘膜下层的微小分泌腺发炎，其病变内有浆液渗出与内皮细胞增殖形成Koplik斑 (An inflammatory reaction occurs in the fine secretor of the buccal mucosa, where serous exudate and proliferation of endothelial cells resu
8、lt in Kopliks spots),10,病理(PATHOGEY)颊粘膜下层的微小分泌腺发炎，其病变内,病理(PATHOGEY),麻疹引起的间质性肺炎为Hecht巨细胞肺炎 (Interstitial pneumonitis resulting from measles virus takes the form of Hecht giant cell pneumonia),11,病理(PATHOGEY)11,病理(PATHOGEY),麻疹皮疹的病理改变：真皮毛细血管内皮增生、血浆渗出、红细胞相对增多形成淡红色斑丘疹(Maculopapular rash consists of proli
9、feration of capillary endothelial cells in skin,serous exudate and relative increase of red cells)疹退后，表皮细胞坏死、角化形成脱屑。皮疹处红细胞裂解，疹退后形成棕色色素沉着。,12,病理(PATHOGEY)麻疹皮疹的病理改变：真皮毛细血管内皮,典型麻疹(Typical measles),潜伏期(Incubation stage)一般为1014天(亦可短至1周)，此期可有轻度体温上升(It lasts usually 1014 days after contact,maybe as short a
10、s 1 week.The temperature may increased slightly)。,临床表现,13,典型麻疹(Typical measles)潜伏期(Incub,典型麻疹,前驱期 (Prodromal stage)指从发热至出疹,一般为3-4天(from fever to rash appearance,usually lasts 3-4 days),临床表现,14,典型麻疹前驱期 (Prodromal stage)临床表现1,典型麻疹,主要表现：发热、上呼吸道炎症、眼结合膜炎、Stimson线(fever,upper respiratory inflammation, con
11、junctivitis ) 麻疹粘膜斑(Kopliks spots),前驱期 (Prodromal stage),临床表现,15,典型麻疹 主要表现：发热、上呼吸道炎症、眼结合膜炎、S,Kopliks spots(麻疹粘膜斑),时间：发疹前24 48小时出现(24-48 hours before the appearance of the rash)；位置：开始对着下臼齿的颊粘膜上；以后累与整个颊部并蔓延至唇部粘膜(initially opposite the lower molars but may spread the rest of the buccal and lip mucosa)。
12、,临床表现,16,Kopliks spots(麻疹粘膜斑) 时间：发疹前,Kopliks spots(麻疹粘膜斑),形态：直径约1的灰白色小点，外有红晕(grayish white dots with 1mm in diameter,usually as small as grains of sand,that reddish areolae)；发展：1天内很快增多，皮疹出现后逐渐消失(They spread rapidly within one day and disappear gradually after the appearance of the rash)。,临床表现,17,Kop
13、liks spots(麻疹粘膜斑)形态：直径约1,18,18,典型麻疹,出疹期 (eruption stage) 在发热3-5天后出现,持续3-5天 出疹顺序:耳后、发际额、面部颈躯干四肢,达手掌、足底 (initially occurring behind the ears and hairline and spreading down from the forehead and face to neck ,the trunk and the extremities).,临床表现,19,典型麻疹出疹期 (eruption stage) 临床表现1,典型麻疹,出疹期 (eruption sta
14、ge)皮疹性质:红色斑丘疹，疹间皮肤正常(red maculupapular rash, there is normal skin among rashes.),临床表现,20,典型麻疹出疹期 (eruption stage)临床表现20,21,21,典型麻疹,恢复期(convalescent period) 皮疹按出疹先后顺序消退,伴有糠麸样脱屑与棕色色素沉着,经710天消失(The rash fades downward in the same sequence in which it appeared .As the rash fades , branny desquamation an
15、d brownish discoloration occur and then disappear within 7-10 days),临床表现,22,典型麻疹 恢复期(convalescent period,并发症(complications),肺炎(pneumonia) 是麻疹常见的并发症，多见于出疹期，继发细菌或其它病毒感染喉、气管、支气管炎(laryngitis,trachitis, bronchitis)心肌炎(myocarditis),23,并发症(complications)肺炎(pneumoni,并发症(complications),麻疹脑炎与亚急性硬化性全脑炎（measles
16、 encephalitis and subacute sclerosing panencephalitis 简称SSPE)结核病恶化(tuberculosis exacerbating)营养障碍与维生素A缺乏症(malnutrition and vitamin A deficiency),24,并发症(complications)麻疹脑炎与亚急性硬化性全,诊 断(DIAGNOSIS),麻疹接触史(exposure to measles previously)典型临床表现(typical clinical manifestations),25,诊 断(DIAGNOSIS)麻疹接触史(exposu
17、re,诊 断(DIAGNOSIS),前驱期鼻咽部找多核巨细胞与尿中检测包涵体细胞(During the prodromal stage, multinucleated giant cells are found in nasopharynx,intrancuclear and intracytoplasmic inclusion bodies cells are found in urine),26,诊 断(DIAGNOSIS)前驱期鼻咽部找多核巨细胞与尿中,诊 断(DIAGNOSIS),ELISA法检测麻疹抗体(Measles virus antibodies become detectab
18、le by ELISA when the rash ppears;testing of acute and convalescent sera shows the diagnostic seroconversion or fourfold increase in titer),27,诊 断(DIAGNOSIS)ELISA法检测麻疹抗体(Me,鉴别诊断,28,鉴别诊断病原全身症状和其他特征皮疹特点发热与皮疹的关系麻疹(,麻疹的流行病学与预防,29,麻疹的流行病学与预防 流行病学(epidemiolo,麻疹的流行病学与预防,流行病学 传播途径： 主要是呼吸道飞沫传播。,预防 切断传播途径：实行“三
19、门”，病人住所、衣物按规定消毒。,30,麻疹的流行病学与预防流行病学预防30,麻疹的流行病学与预防,流行病学,预防保护易感人群：主动免疫(active immunization)，被动免疫(passive immunization)。,易感性: 人类对麻疹病毒普遍易感。易感者： 未曾患过麻疹或未接种过麻疹疫苗者。,31,麻疹的流行病学与预防流行病学预防易感性:31,治 疗(TREATMENT),无特异抗病毒治疗，只有支持治疗和对症治疗。(There is no specific antiviral therapy ;treatment is entirely supportive and sy
20、mptomatic treatment),32,治 疗(TREATMENT) 无特异抗病毒治疗，只有支持治,治 疗,一般治疗 给予易消化的富有营养的食物，补充充足水分；保持皮肤、粘膜清洁,33,治 疗一般治疗 33,治 疗,一般治疗 卧床休息，房内保持适当的温度和湿度，有畏光症状时房内光线要柔和 (bed rest , keeping comfortably humidification and warm of the room ;patients with photophobia should be protected from exposure to strong light)。,34,治
21、 疗一般治疗 卧床休息，房内保持适当的温度和湿度，有畏,治 疗,对症治疗 高热时可用小量退热剂。慎用退热药，烦躁者镇静。剧咳时镇咳祛痰。继发细菌感染可给抗生素，补充维生素A。,35,治 疗对症治疗 高热时可用小量退热剂。慎用退热药，烦躁者,麻疹的新进展,麻疹的发病年龄呈两极分化趋势婴儿麻疹增多，主要发生在8个月以前,多为非典型病例；大年龄患者增多。 麻疹的不典型病例增多。 发病高峰季节后移至3-5月份,36,麻疹的新进展 麻疹的发病年龄呈两极分化趋势婴儿麻疹增多，主要,麻疹的并发症的变化： 心肌炎明显增多，且年龄越小，发病率越高。二次麻疹发生率: 在1%左右，其中60%发生在第一次麻疹二年以内。虽然麻疹病例增多，但病死率却很低。,麻疹的新进展,37,麻疹的并发症的变化：麻疹的新进展37,麻疹前驱期最有诊断价值的表现 ( ) A 发热3-5天 B 有卡他症状 C Kopliks spots D 可见少数斑丘疹E 有麻疹接触史,麻疹提问1,38,麻疹前驱期最有诊断价值的表现 ( )麻疹,汇报结束,谢谢大家!,请各位批评指正,39,汇报结束谢谢大家!请各位批评指正39,谢谢观赏,谢谢观赏,
