人禽流感 临床和诊疗

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人禽流感 临床和诊疗. 南昌大学一附院呼吸内科 张 伟 zhangweiliuxin @163. com 2006.10.25. 主要内容. 概述 流行病学 临床表现 + 辅助检查 肺部病理 诊断 + 鉴别诊断 治疗. 什么是禽流感?. 禽流感是由一种甲型流感病毒亚型引起的禽间传染性疾病综合征,被国际兽疫局定为A类传染病。( 1878 年意大利 - 欧洲鸡瘟, 1955 年确定为 AHV) 非致病性禽流感:无症状,仅产生 H-Ab 。 低致病性禽流感 H9N2/H7N7 :呼吸道症状轻,食量↓、产蛋↓,零星死亡 - PowerPoint PPT Presentation

Text of 人禽流感 临床和诊疗

  • [email protected]

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  • 1878-1955AHV)H-AbH9N2/H7N7H5N1

  • Lancet 2003;362:1733-45

  • ?51 1997>120H5N1>50%

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  • 19971851711-12189/

  • 172-4ARDSReye

  • 199718810
  • 111014-301591612+ 32-4 38.5~400C

  • Case 1F, 30 y2004-01-132004-01-23+3: PE: T 39.90C, P 90, BP 110/60, RR 20, SpO2 98%. : WBC 4.8 G/L (PMN 67%), PLT 139 G/L, BUN 3.3mmol/l. CXR:.: Tamiflu, Doxycyclin.

  • Case 1 12/01/0416/01/0419/01/0420/01/04

  • Case 2F, 23 y2004-01-13, 2004-01-23 1:PE: T 39.60C, P 100, BP 100/60, RR 20/min. SpO2 99%. WBC 5.6 G/L (PMN 69%), PLT 131 G/L, BUN 3.4mmol/l. CXR: : Antivirus: Tamiflu, Antibiotics: Tequin, Doxycyclin.

  • Case 2

  • Case 3M,35yPE: T39. 2P90/R21/BP110/70mmHg90/ WBC 3.6 G/L PLT 87 G/L,

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  • Alveolar wall: hyaline membrane formationinterstitial areas: reactive fibroblasts Alveolar spaces: filling /w fibrinous exudates spleen: numerous atypical lymphoid cells

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  • There was focal neutrophil infiltration at intervillous lacuna of the placenta, and lymphocyte infiltration in the matrix of placenta, which suggested that the embryo be infected by A/H5N1 virus

  • Presentation at hospital Fever, cough and dyspnea100% Sore throat 71% Myalgia 53% Diarrhea 41% Rhinorrhea 53% Vomiting 24% Abdominal pain 24%Clinical Description of Influenza(H5N1) in Thailand

  • Laboratory finding Survived Died p-value (n = 5) (n = 12)No. Tested 4 10 - SGOT median (IU) 101.5 202.5 0.282SGPT median (IU) 49 51 0.325Laboratory Results of 17-H5N1 Patients,Thailand, 2004 (2)

  • Radiologic Findings of 17-H5N1 Patients,Thailand, 2004 Radiologic Survived Died P findings (N=5) (N=12)

    CXR (early) - interstitial1 1 0.51 - lobar, patchy4 11 CXR (late) - ARDS (diffuse bilateral)1 12 0.02 - No ARDS4 0

  • : 21A/H5N1: 2005.10.28~2006.08.31: 29y (6~41 y, 516): 6 15: 16541

  • F/12 and M/922 chickens and 5 ducks

  • :5 (2-10 ) : 6 (3-10 )AI?

  • 100 100 87.5 68.8 31.2 43.8 62.5 50.0 31.3 31.3 37.5 17 / 17

  • ?6/21?1122 (4 & 2 )11

  • (81.3 %) (50%

  • (1)

  • (2)------ ALT 80~244 IU/L (80%)AST 66~888 IU/L (100%)LDH 566~3417 IU/L (100%)CK 232~30090 IU/L (100%)CK-MB 27.2~5863 IU/L (85.7%)

  • : 71.4%, 20.5~33.8 g/L: 40%1~3 g/L

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  • 2005-11-07

  • -including sinus bradycardia, tachycardia, ST-T changes, atrial fibrillation9:30 Nov 9, 200515:30 Nov 11, 2005

  • ///H5N1+H5N14

  • 1: 2005-11-8 PM1 2: 2005-11-8 PM2 3: 2005-11-8 AM HA H5RT-PCR750::CDC

  • NA N1RT-PCR1: 2005-11-8 PM1 :2: 2005-11-8 PM2 3: 2005-11-8 AM :CDC

  • Diagnosis

  • 17 M1NP + /AFV/AFVAb4

  • H5N1-VNO(HCW)

  • H5N1-V :- 1. H5N1 (H5N1) 2. 1 3. PPE775mg/d 5-7d100-200mg/d 5-7d

  • 4875mg/d 5-7dM2(100-200mg/d 5-7d)-

  • 18781955 10011515571380120nmRNAHN16HH1H169NN1N9H5N1H9N2H7N7H7N2H7N3H5N1 511997126 H5N1 45001910H5N1 2003H5N163

    83H5N1H5N1

    WBC:4-10LY:0.8-4PLT100-300