传染病学教案课件7流行性出血热.pptx
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1、Hemorrhagic Fever with Renal Syndrome Zhang Dazhi,M.DDepartment of Infectious DiseaseThe second hospital of CMUOverviewPathogen:Hantaviruses Clinical features:fever;renal failure;shock;hemorrhagic manifestationsHemorrhagic fever with renal syndrome(HFRS)includes a group of clinically similar illness
2、es nEpidemic hemorrhagic fever(China)nKorean hemorrhagic fever(Korean)nNephropathis epidemica(PuumalaVirology of HantaviruseBelong to the family Bun-yaviridaeSpherical enveloped viruses about 80-120 nm in diameterGenome consists of three single-stranded,negative sense RNA segments-S,M,Ln S(small):en
3、codes neucleocapsid proteinn M(medium):encodes envelope glycoproteinn L(large):encodes polymeraseThe viruses that cause hemorrhagic fever with renal syndrome include:nHantaannDobrava-BelgradenSeouln PuumalaSin Nombre virus can cause hantavirus pulmonary syndrome(America)Virology of HantaviruseEpidem
4、iology Sources of transmission:rodent reservoirs Virus speciesReservoirEpidemic&endemic areasHantaan Striped field mouse(Apodemus agrarius)Korea,China,Eastern Russia SeoulNorway rat(Rattus norvegicus)WorldwidePuumalaBank voles(Clethrionomys glareolus)Western Europe Dobrava-BelgradeYellow-necked fiel
5、d mouse(Apodemus flavicollis)BalkansStriped field mouse Norway rat Bank voles Yellow-necked field mouse pOccurs mainly in Europe and Asia Striped field mouseApodemus agrarius Norway rat Rattus norvegicus,Bank volesClethrionomys glareolusYellow-necked field mouseA.flavicollisEpidemiology Route of tra
6、nsmissionnExposure to aerosolized urine,droppings,or saliva of infected rodentsnDirect introduction of infectious material through broken skin or onto mucous membranes nThrough rodent bites from infected animalsnFrom mother to childnTransmission from human to human is extremely rare.Epizootic CycleR
7、odent breedingEpidemiologySusceptibility of populationnPeople are generally susceptiblenCommonly reported in male adultnSubclinical infection rate is 2.54.3%nStable and persistent immunity PathogenesisImmune mechanisms may play an major pathogenic rolenViremia is only present in early stage of infec
8、tion No cytopathic effectnAt the time that severe symptoms begin Viremia is absentSpecific antibodies and T cells are detectedmarked cytokine production,kallikrein-kinin activation,complement pathway activationPathogenesisBasic pathological changes Systemic microvascular endothelial edema,degenerati
9、on and necrosisThe most dramatic damage is seen in the kidneysImmune mediated vascular endothelial injury Increased capillary permeabilityPlasma extravasationInsufficient blood volumePrimary shockoccurs before oliguric stageMassive hemorrhageorSecondary infectionorInsufficient water-electrolyte supp
10、ly during polyuric stageInsufficient blood volumeSecondary shock:occurs after oliguric stagePathogenesis:shockPathogenesis:hemorrhage tendencyDamage of the blood vessel wallThrombocytopenia Uremic bleeding defectsIncrease of heparinlike substances DIC Decreased blood flow Direct injury to the kidney
11、Pathogenesis:acute renal failure Histopathologic changes in kidney(cortex)Small arrow:interstitial edema with mild infiltration of mononuclear cellsLarge arrow:degeneration of renal tubules Arrow head:proteinaceous casts and exudate Histopathologic changes in kidney(medulla)Most prominent change in
12、the medulla is welldefined necrotic lesion(asterisk)*Intracranial hemorrhage in HFRS patientClinical Manifestations:overviewIncubation period:usually 1 to 2 weeksA triad of fever,hemorrhage,and renal insufficiency5 progressive stages:Febrile stage Hypotensive stage Oliguric stage Polyuric stage Conv
13、alescent stageSkipping of phase is common in atypical and mild individuals.The individual phases may overlap in severe cases.Clinical Manifestations:Febrile stageAbrupt onset of fever lasting 3-7 daysGastrointestinal discomfort Anorexia,nausea,vomiting and abdominal pain Systemic toxic symptoms Myal
14、gia,triad of pains(Headache,lumbago and retroorbital pain)Clinical Manifestations:Febrile stageSigns of Capillary injuryn Congestionn Hemorrhagic tendencyn Exudation and edemaClinical Manifestations:Febrile stageCongestionnDermathemia:triad of flushings Flushing over Face,the V area of the neck(drun
15、ken face),and the backnMucosal hyperemia Conjunctival suffusion,pharyngeal injectionDrunken faceClinical Manifestations:Febrile stageHemorrhagic tendencynDermatorrhagia Petechiae often develop in areas of pressure,axilla Ecchymosis in severe case nMucosal bleeding Petechiae in the conjunctivae,soft
16、palatenVisceral bleeding Epistaxis,bloody stool,hemoptysis,cerebral bleedingPetechiae on axillaEcchymosis in severe caseSubconjunctival hemorrhagePetechiae on the soft palateClinical Manifestations:Febrile stageExudation and edema cause painnPeriorbital edema,chemosis nRetroperitoneal edemanAscitesp
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