Self-introduction

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ü Lemology

ü Infectious diseases

ü Contagious diseases

ü Communicable diseases

ü Transmissible diseases
Ø Biology

Ø Immunology

Ø Parasitology

Ø Epidemiology

Ø Pediatrics
ID is :

ü A clinical medicine

ü A part of internal medicine

ü An important common medical science

this subject

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l some of ancient-infectious diseases eliminated

l Smallpox

l Plague

l Tetanus of newborn

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Global

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Paleo-ID rekindled：

Ø TB、 typhoid fever

Ø Measles、dengue fever

Ø Gonorrhea、syphilis、STD

Ø etc、……………………………………

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Situation in CHINA and all oversea ?

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2005年人感染高致病性禽流感H5N1
Avain flu
2009年甲型流感
H1N1
（swine flu）

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年至今
2009
2010--superbug
NDM-1

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 2006~2010年底？SFTS
severe fever with thrombocytopenia syndrome

蜱虫叮咬导致多人死亡，出现的“发热伴血小板
综合征”病例，经血液检测证实患者感染的是

新型布尼亚病毒？

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Animal to human

2013年感染禽感流H7N9诊治
2014，4-2015，12--EBOLA

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Microcephaly
Seasonal influzena

——H3N2

——pdmH1N1

——type B

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 ID is still:

ü A great threat to the health of people

ü Caused by different pathogens

ü To possess infectivity

ü To form epidemic
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已经发现感染人的有以下：

1. 1965 HCoV-229E（α） 轻

2. 1967 HCoV-OC43（β） 轻

3. 2003 SARS-CoV （β） 重 37个国家9.6%

4. 2004 HCoV-NL63（α） 轻

5. 2005 HCoV-HKU1（β） 轻

6. 2012 MERS-HCoV（β） 重 2019年底

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7. 20200211 SARS-CoV-2（β） 介于SARS与MERS之间？
1. 1937年 冠状病毒首先从鸡身上分离出来。
2. 1965年 Tyrrell 和Bynoe 在1965年将病人鼻腔洗液接种人胚气管培养，分离出人

类冠状病毒HCoV-229E。由于在电子显微镜下其形态看上去像
中世纪欧洲帝王的皇冠，因此命名为“冠状病毒”
3. 1967年 人类冠状病毒HCoV-OC43被发现
4. 1975年 病毒命名委员会正式命名了冠状病毒科
5. 2003年 人类冠状病毒SARS-CoV首先在广东被发现
6. 2004年 人类冠状病毒HCoV-NL63首先在荷兰发现
7. 2005年 人类冠状病毒HCoV-HKU1在香港被发现
8. 2012年 人类冠状病毒MERS-HCoV首先沙特被发现
9. 2020年 新型人类冠状病毒在武汉被发现
到底是“同胞兄弟”太多，还是变异性太强，冠状病毒在人类社会不断登场

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 已经发现感染人的有以下：

1. 1965 HCoV-229E（α） 轻

2. 1967 HCoV-OC43（β） 轻

3. 2003 SARS-CoV （β） 重 37个国家76/8089=9.6%

4. 2004 HCoV-NL63（α） 轻

5. 2005 HCoV-HKU1（β） 轻

6. 2012 MERS-HCoV（β） 重 2019年底1/2468=34.5%

7. 20200211 SARS-CoV-2（β） 介于SARS与MERS之间？

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在这个星球上对人类永久主导地位
产生最大的威胁是病毒！！

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Ø Cambridge university Pro.Cliff predict that：“we will

always face the challenge of ID，containing：

——paleo- CD causes old and new problems

——new CD causes new or old problems

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 Infection is the detrimental
colonization of a host organism by a foreign
species.

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 Definition of infection
u Complex process of interaction between
pathogen and human body

u Infection is composed of three factors:

pathogen, host and environment
Infectious diseases：
caused by pathogenic microbial agents: including virus,
bacteria, fungi, protozoa, parasites, chlamydia, rickettsia,
mycoplasma, spirochete, and helminthes and aberrant proteins
known as prions.

Communicable diseases：
Infectious + communicable

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 感染性疾病
传染病
（Infectious Diseases）
（Communicable Diseases)

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Results of infection: Infection spectrum
u Clearance of pathogen

u Covert infection: subclinical infection

u Overt infection: clinical infection or apparent infection

u Carrier state

u Latent infection
Epidemic process and influential factor
of infectious diseases
ü Source of infection

ü Route of transmission

ü Susceptibility of population
Source of infection (basic conditions)

——Patients (acute, chronic)

——Covert infection

——Carrier

——Infected animal
Route of transmission
Ø Contact transmission (direct and indirect)

Ø Food water borne

Ø Insects borne

Ø Blood borne

Ø Soil borne

Ø Air-borne
Route of transmission

Ø Horizontal transmission

Ø Vertical transmission
Susceptibility of population

——Human immune ability decrease

——Pathogen mutation

——Susceptible person

——Periodicity
Features of ID
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Epidemiological features
Epidemicity: sporadic occurrence, epidemic，

pandemic, outbreak

Seasonality: local and exotic

Endemicity

Foreignness
 Post infection immunity

Pathogen Time of immunity

Viral Life-long

Bacteria Shorter

Helminthes No protective

Protozoa Shorter
Course of disease development phase

Ø Incubation period: diagnosis , qurantine period

Ø Prodromal period

Ø Period of apparent manifestation

Ø Convalescent period

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 Relapse
—— After patients enter into stage of

recovery for some time, incipient symptoms

occur again because of pathogen incubating
in patients’ tissue increasing again

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 Recrudescence
——When pathogenetic condition enters into
stage of recovery，body temperature
decreases but not to normal，and other
symptoms and signs decrease but not
disappear completely, then temperature rise
again, other symptoms and signs become
worse again.

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u Fever

u Eruption

u Toxemic symptoms

u Reaction of mononuclear phagocyte system

Types of fever:
u Sustained fever

u Remittent fever

u Intermittent fever

u Irregular fever
 1、Sustained fever

In 24h, body temperature fluctuate

scope < 1℃

typhoid fever、camp fever

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2、Remittent fever

In 24h body temperature fluctuate scope >

1℃，but the lowest temperature is > the normal
level (37.4℃)

typhoid fever paracmasis、HFRS

(hemorrhagic fever with renal syndrome)

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3、Intermittent fever

In 24h body temperature fluctuation

between fever and common temperature

Malaria、septicemia

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4、Irregular fever

Temperature curve irregularity

TB、RF、carcino-febrilis

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Eruption
u Date of eruption: time

u Location of eruption: distribution

u Succession

u Form of rash: Exanthema or Enanthema

——Important for diagnosis and differential diagnosis

Time (d)——the definate date in the disease

1st——chickenpox, varicella 4th——measles

2nd——scarlet fever 5th——typhus

3rd——smallpox 6th——typhoid fever

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 Classification：

Ø Appearance: exanthema maculosum+maculopapular eruption

Ø Hemorrhage: petechia+hyperaemia eruption

Ø Location: exanthema or enanthema

Ø Etiology: infectious+non-infectious

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麻疹——Koplik’s spots

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 水痘
Small pox 85
 猩红热
(scarlet fever)
口周苍白
面部潮红
皮折红线
（巴氏线）
束臂试验
（阳性）
 草莓舌
Strawberry tongue
 杨梅舌
Waxberry tongue
 脱皮
exuviation
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l Ramsay-Hunt syndrome

l 病毒侵犯膝状神经节

l 影响面神经的运动和
感觉纤维

l 产生面瘫、耳痛及外
耳道疱疹三联症
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l 群集簇状小水疱
沿神经带状排列

l 单侧分布

l 不过中线

l 有明显神经痛

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Toxication symptoms：

l Light：tired、general malaise、headache、

muscle ache， etc.

l Heavy：CNS、CS、RS、liver、kidney

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Reaction of mononuclear phagocyte system

——Hepato-splenomegaly

——Lymphonodus enlarged
ü Epidemiological datas：history

ü Clinical manifestion

——Symptoms and signs

ü Laboratory findings
 ID diagnosis points
v Epidemiology data:

—region、season、contiguity、propensity、innoculation

v Clinical data:

—Symptoms and signs

v Laboratory data

—routine examination, pathogen examination

—molecular biology detection, immunologic test, image

analysis,…………………
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Methods used to diagnosis of ID-Non-specific

Ø Routine examination of blood, urine, feces

Ø Bio-chemical examinations

Ø Endoscope examinations

Ø Image examinations
Specific for microorganism

ü Etiological examinations

——Direct exam

——Isolation of pathogen

ü Molecular biological examinations

ü Immunological examinations
 ID laboratory examination

Ø Routine examination：blood+urine+stool

Ø Etiology examination：detection directly+isolation culture

Ø Molecular biology detection：PCR

Ø Immunologic test：Ab+Ag+Ig+OKT+skin test

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Principle:
– Early discovery, treatment, isolation, degermation

Treatment:
– General+Supportive treatment+symptomatic treatment

– Etiological agent treatment

– Restorative +chinese medical therapy

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u General and supporting therapy
Isolation of patients, rest, diet, nursing

u Pathogen or specific therapy

u Symptomatic therapy

u Rehabilitation: physiotherapy acupuncture

u Chinese herbs or tradition medicine

Principle management of CD

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 rophylaxis

ü Administer infection sources

ü Cut off route of transmission

ü Protect susceptible population

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 ID reportingsystem

public health incident management regulation

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 ID prevention and cure law

ü Three classes

ü Categorization management

ü Report system

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l Management of source of infection
35 kinds of notifiable CD divided into 3 class
First class: 2 kinds. Reported 6h in city, 12h in country
Second class: 24 kinds. reported 12h in city and country
Third class: 9 kind

l Cut off of route

Personal hygiene, public hygiene, insecticide, disinfection
l Protect susceptible population
Active immunization
Passive immunization
 35 kinds of ID
Class one:
plague, cholera
Class two:
viral hepatitis, bacillary dysentery and intestinal amebiasis, typhoid
fever and paratyphoid fever, AIDS, gonorrhea , avariosis,
poliomyelitis, measles, pertussis, diphtheria, epidemic cerebrospinal
meningitis, scarler fever, epidemic hemorrhagic fever, rabies,
leptospirosis, brucellosis, anthrax, typhus, kala-azar, epidemic
encephalitis B, malaria, dengue fever, lung tuberculosis, fetal tetanus
Class three:
schistosomiasis , filariasis, hydatid disease, leprosy , influenza,
mumps, rubella, infectious dysentery, acute hemorrhagic
conjunctivitis