复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）呼吸系统_Pulmonary Tuberculosis

复旦大学附属中山医院 呼吸科暨呼吸病研究所 上海市重点学 Pulmonary Tuberculosis Jing ZHANG(张静),MD,PhD zhang jing @zs-hospital shcn Department of Pulmonary medicine Zhongshan Hospital Fudan University MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital Pulmonary Tuberculosis Jing ZHANG (张静), MD, PhD zhang.jing@zs-hospital.sh.cn Department of Pulmonary Medicine Zhongshan Hospital Fudan University

OUTLINE ° Etiologic agents Epidemiology Pathogenesis and immunity Clinical manifestation Lab investigations and diagnosis Treatment (drugs, regimen, drug-resistant TB Prevention(vaccine preventive treatment, disease control) MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital OUTLINE • Etiologic agents • Epidemiology • Pathogenesis and immunity • Clinical manifestation • Lab investigations and diagnosis • Treatment (drugs, regimen, drug-resistant TB) • Prevention (vaccine, preventive treatment, disease control)

Robert Koch Discovers Mycobacterium(1882)

MBBS project, Zhongshan Hospital Dr.T.V.R ao Robert Koch Discovers Mycobacterium (1882)

Etiology · Mycobacteria M. tuberculosis &m, bovis M tuberculosis-90% of human disease M. avium, M intracellulare in AIDs -Atypical TB Bacilli aerobic, non motile, no toxins no spore. Mycolic acid wax in cell wall Carbol dye-Acid alcohol fast(AFB) MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital Etiology • Mycobacteria — M. tuberculosis & M. bovis — M. tuberculosis-90% of human disease — M. avium, M.intracellulare in AIDS - Atypical TB • Bacilli, aerobic, non motile, no toxins, no spore. • Mycolic acid wax in cell wall • Carbol dye - Acid & alcohol fast (AFB)

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Epidemiology Infects one third of world population. 8-10 million new cases every year 3 million deaths due to TB every year 2/3 patients are young adults Drug resistance is increasing 结核病人 MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital Epidemiology • Infects one third of world population..! • 8-10 million new cases every year • 3 million deaths due to TB every year • 2/3 patients are young adults • Drug resistance is increasing

A Global Emergency The tuberculosis in the beginning of the 21st Century declared as global Emergency(WHo) Inder privileged population Crowding, Poverty, malnutrition, single male ! -economic burden Since 1985 incidence is increasing in west AIDS, Diabetes, Immunosuppressed patients Diabetes Drug resistance MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital A Global Emergency The Tuberculosis in the beginning of the 21st Century declared as Global Emergency (WHO) • Under privileged population - — Crowding, Poverty, malnutrition, single male..! – economic burden. • Since 1985 incidence is increasing in west — AIDS, Diabetes, Immunosuppressed patients, Diabetes, Drug resistance

Tuberculosis in the era of hv/aids °HⅣ/ AIDS epidemic led to large increase of Smear negative pulmonary tuberculosis which in turn has led to poor treatment outcomes, and early mortality Frequently involves Lower lobes of Lungs MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital Tuberculosis in the era of HIV / AIDS • HIV / AIDS epidemic led to large increase of Smear negative pulmonary tuberculosis which in turn has led to poor treatment outcomes, and early mortality • Frequently involves Lower lobes of Lungs

Tuberculosis -Important communicable disease spread by respiratory route Infection sources: patients wit ith infectious pulmonary TB, esp sputum positive ones a disease of respiratory transmission: droplets Patients with the active disease(bacilli expel them into the air by coughing, sneezing, shouting, or any other way that will expel bacilli into the air Determinants of transmission The probability of contact with a case of tuberculosis the intimacy and duration of that contact the degree of infectiousness of the case the shared environment of the contact; crowding poor ventilated Susceptible population elderly people, children, ICH (HIV, DM.) MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital Tuberculosis - Important communicable disease spread by respiratory route • Infection sources: patients with infectious pulmonary TB, esp. sputum positive ones • A disease of respiratory transmission: droplets — Patients with the active disease (bacilli) expel them into the air by coughing, sneezing, shouting,or any other way that will expel bacilli into the air • Determinants of transmission — The probability of contact with a case of tuberculosis — the intimacy and duration of that contact — the degree of infectiousness of the case — the shared environment of the contact: crowding, poor ventilated • Susceptible population — elderly people, children, ICH (HIV, DM…)

Pathogenesis of TB Infection Immunity MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital Infection - Immunity Pathogenesis of TB