肺炎简介.ppt
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肺炎简介.ppt
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肺炎簡介,高雄醫學大學感染內科陳彥旭,WorldInfectionassociatedmortality1997/2002,(21,000),(282,000),(285,000),(81,000),(745,000),(1,124,000),(2,866,000),(2,001,000),(1,644,000),(3,871,000),WHOTheworldhealthreport2002data,(140,000),(275,000),(410,000),(605,000),(960,000),(2,100,000),(2,300,000),(2,455,000),(2,910,000),(3,745,000),2002,1997,CommunityAcquiredPneumonia,Epidemiology:
4-5millioncasesannually500,000hospitalizations45,000deathsMortality2-30%65yrsmortalitydisproportionatelyhighin65yrs,Bartlett.CID1998;26:
811-38.,CommunityAcquiredPneumonia,AdeelA.Butt,MD,#in1000s,Incidence,CommunityAcquiredPneumonia,AdeelA.Butt,MD,#in1000s,Mortality,RiskFactorsforpneumoniaagealcoholismsmokingasthmaimmunosuppressioninstitutionalizationCOPDPVDdementia,CommunityAcquiredPneumonia,IDClinics1998;12:
723.AmJMed1994;96:
313,何謂肺炎?
肺炎的診斷依據?
肺炎的定義為何?
肺炎是否一定會發燒?
不發燒是否就一定不會是肺炎?
肺炎的治療?
呼吸疾病病程與症狀變化,CraigC.Freudenrich,Ph.D.,病毒感染呼吸道細胞,被感染的細胞死亡,杯狀細胞分泌黏液,干擾素與細胞酵素引起發炎,死亡的上皮細胞(病毒)發炎細胞分泌的黏液鼻咽喉移生的細菌增殖,A.NasalcavityB.PharynxC.LarynxD.TracheaE.AlveoliF.BronchialtreeG.Diaphragm,吸引發炎細胞聚集,發燒、喉痛、噴涕,發燒、流鼻水,傳染期,痰,中耳炎,鼻竇炎,支氣管炎,菌血症,病毒血症,肺炎,膿胸,社區性肺炎的病原,微生物,典型肺炎(細菌)S.pneumoniaeH.influenzaeS.aureusGNBOthers非典型肺炎Legionellaspp.M.pneumoniaeC.pneumoniae病毒性吸入性肺炎無病原診斷,北美1967-95,英國胸腔學會1987,1966-95,2030%2060%310%35%310%35%1020%28%16%46%215%610%3060%,6075%45%15%RareNDNA25%518%NA816%NDNA,65%12%2%1%3%12%4%7%1%3%NDND,常見呼吸道病原之感染季節,7,8,9,10,11,12,1,2,3,4,5,6,副流感病毒,流行性感冒病毒A&B,Qfever,鏈球菌GAS,肺炎球菌Sp,退伍軍人肺炎桿菌Lp,嗜血桿菌Hi,月份,黴漿菌Mp/披衣菌Cp,腺病毒,冠狀病毒,原發性肺炎,次發性肺炎,伺機性肺炎,CMV,PCP,Fungus,肺炎的診斷,臨床診斷肺炎的依據臨床症狀理學檢查CXR檢查一般檢驗:
ABGCBC/DCCRP,肺炎的病因診斷?
培養細菌染色:
快速抗原:
血清抗體:
分子生物:
PCR,典型肺炎與非典型肺炎比較表,黴漿菌肺炎(Mp)流行病學(Seattle,1963-75),SeattleUS1963-75,Incidence/1,000/year,Definition:
1.Mptiter1:
322.Mptiter4xrise3.Mpisolated,高雄地區披衣菌肺炎(Cp)血清流行病學,年齡,%,N=,97,26,21,312,171,73,84,223,78,1085,Wang1993,MIFIgG1:
16,73.4%,臨床診斷,病因診斷,培養染色:
Gram,AFS快速抗原:
血清抗體:
分子生物:
PCR,肺炎的診斷,流行病學資訊,臨床症狀理學檢查,CXR一般檢驗,季節性地域性接觸史傳染源與傳播力潛伏期,痰(採集方式)咽喉拭子肋膜液血液尿液,肺炎治療,經驗治療,專一性治療,檢驗方法,適當的檢體與採集,輔助治療,肺炎的病因診斷方式?
顯微鏡抗原偵測抗體-免疫螢光-血清微生物培養分子生物學,檢體種類,適合微生物,痰氣管鏡抽取液胃液痰、氣管抽取液尿液鼻腔液、痰液血液痰氣管鏡抽取液胃液痰、氣管抽取液,Sp,Hi,GNB,GPC,Tb,FungusSp,Hi,GNB,GPC,Tb,fungusTbVirus(Adv,Flu,PIF,RSV,SARSLegionellaLegionella,virus-specificMp,Cp,Ct,Legionella,Cb,Flu,Adv,CXB1-6,Mp,Bacteria,Legionella,TbMp,Bacteria,Legionella,TbTbAnyextrinsicpathogens,臨床診斷與抗生素的使用,OPDantibioticsprescription,dataofCDC,肺炎的治療,單一抗生素治療,支持性治療,強化性抗生素治療,散彈槍抗生素治療,預防性抗生素治療?
臨床診斷,病因診斷,肺炎治療,經驗治療,專一性治療,輔助治療,單一抗生素治療,化痰劑蒸氣物理治療,肺炎治療,臨床診斷,ResistanceBurdeninTaiwan,SMART2000,臺灣地區主要的呼吸道致病菌抗藥性,HsuehPR.AntimicroAgentsChemother2000,肺炎治療觀念與方法,社區性支氣管肺炎或肺炎,病毒性肺炎,外因性肺炎,病毒感染併發細菌性性肺炎,院內感染性肺炎低抵抗力肺炎,症狀治療體液補充預防性抗生素?
症狀治療體液補充處理併發症選擇治療性抗生素,典型肺炎:
S.pneumoniaeH.influenzaeOthers,非典型肺炎:
M.pneumoniaeC.pneumoniaeLegionellaspp.Environmental,S.pneumoniaeH.influenzaeLegionellaspp.Enterobacteriae,AdenovirusInfluenzaParainflu.RSVChickenpox,%,%,%,常見呼吸道疾病的抗微生物製劑選擇,PenicillinAmoxicillinAmoxi/Clavu-Ampi-/Sulbact-TetracyclineErythromycinAzithromycinCefotaximeCefuroximeTrimeth-/Sulfa-Levofloxacin,肺炎球菌,嗜血桿菌,厭氧菌,GNB,黴漿菌,匹衣菌,Legionella,+-+/-+,-+-+,+-+,-+-+/-+,-+-+,-+-+,-+-+,Invitro,PneumococcalDiseaseandPneumococcalVaccines,EpidemiologyandPreventionofVaccine-PreventableDiseases,RevisedDecember2004,Streptococcuspneumoniae,Gram-positivebacteria90knownserotypesPolysaccharidecapsuleimportantvirulencefactorType-specificantibodyisprotective,PneumococcalPneumoniaClinicalFeatures,AbruptonsetFeverShakingchillsProductivecoughPleuriticchestpainDyspnea,tachypnea,hypoxia,PneumococcalPneumonia,Estimated175,000hospitalizedcasesperyearUpto36%ofadultcommunity-acquiredpneumoniaand50%ofhospital-acquiredpneumoniaCommonbacterialcomplicationofinfluenzaandmeaslesCase-fatalityrate5%-7%,higherinelderly,PneumococcalDiseaseEpidemiology,ReservoirHumancarriersTransmissionRespiratoryAutoinoculationTemporalpatternWinterearlyspringCommunicabilityUnknownProbablyaslongasorganisminrespiratorysecretions,InvasivePneumococcalDiseaseIncidencebyAgeGroup1998,*Rateper100,000populationSource:
ActiveBacterialCoreSurveillance/EIPNetwork,InvasivePneumococcalDiseasebyAgeandYearChildren5Years,1998-2002*,1yr,2yrs,3yrs,4yrs,1yr,*2003dataarepreliminary.Source:
ActiveBacterialCoreSurveillance/EIPNetwork,Agegroup,PneumococcalPolysaccharideVaccine,Purifiedcapsularpolysaccharideantigenfrom23typesofpneumococcusAccountfor88%ofbacteremicpneumococcaldiseaseCross-reactwithtypescausingadditional8%ofdiseaseNoteffectiveinchildren2years60%-70%againstinvasivediseaseLesseffectiveinpreventingpneumococcalpneumonia,PneumococcalConjugateVaccine,Pneumococcalpolysaccharideconjugatedtonontoxicdiphtheriatoxin(7serotypes)Vaccineserotypesaccountfor86%ofbacteremiaand83%ofmeningitisamongchildren90%effectiveagainstinvasivediseaseLesseffectiveagainstpneumoniaandacuteotitismedia,PneumococcalPolysaccharideVaccineRecommendations,Adults65yearsofagePersons2yearswithchronicillnessanatomicorfunctionalaspleniaimmunocompromised(disease,chemotherapy,steroids)HIVinfectionenvironmentsorsettingswithincreasedrisk,PneumococcalConjugateVaccine,Routinevaccinationofchildrenage7monthsrequirefewerdoses,謝謝收看,病人常在你身邊正確且適當配戴口罩正確且勤洗手,
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