typhoid

Frequentlyaskedquestion（inEnglish）

PartINounexplanation

tinfection/subclinicalinfection：itmeansonlyaspecialimmuneresponwithoutorwith

verymilddamagetothehostafterthepathogennteredwhichcanbediagnodbyrologic

meanswithdemonstrationofeitherasinglehightiterorafourfoldriin

ientshaven'tanysymptomsandsignsclinically,noc

socalledsubclinicalinfection.

-waterfever:AcomplicationofMALARIA,FALCIPARUMcharacterizedbyanacute

intravascularhemolysis,hemoglobinuriaandhemolyticjaundicewhentheredbloodcellsare

destroyedandlyticinthebloodves，lverepatientscanresultinacuterenalfailureMost

commomlyinthowhohavetakenantimalarialtreatmentirregularlyoraredeficientin

rovokedbyadministeringprimaquineorchlorquine,so

calledhemolyticurinemicsyndrome

rstate病原携带状态）:itisapersonwhoiscolonizedwithanorganismbutshowsno

evidenceofdia,erisavery

importantsourceofinfectionastheorganismscanbedisminatedfromhim.

infection（潜伏性感染）:itmeansanorganismentersahostandliesdorman静止的）

foraperiodoftime,possiblyforyears,beforeproducingdiaasthehost'simmunity

decread.

veness侵袭力）:theabilityoftheagenttoenterandtomovethroughtissue.

ofinfection（传染源）：itisreferredtoapersonoranimalinwhichthepathogenstayand

multiplyandcanbedisminated.

ftransmission传播途径）:theroutethepathogenenteredanothersusceptibleafterbeen

disminatedfromthesourceofinfection.

tible（易感者）:itisreferredtoapersonwholacksimmunitytoaspecificinfectious

dia.

e复发）:itmeansthereturnofsymptomsaftertheyhaveapparentlyceadduring

convtenen

intyphoidfever,malaria,etal.

escenee再燃）:itmeansthereappearaneeofsymptomsaftertemporarycessation.

nedfever（稽留热）:highfever,lastingandlittlechangein24hours,usually<1degree.

Oftenenatfastigiumoftyphoidfever,pticemia,andEHF.

entfeve（r弛张热）:highfever,temperaturechanges>1degreein24hours,butthelowest

eeninthe

defervascenceoftyphoidfeverorEHF.

ingfever回归热）：veraldaysofhighfeverwithinterruptionofafewdays'normality.

typicalfeverpatterninbrucellosisandrelapsingfever.

14.1ntermittentfever（间歇热）：temperaturefluctuatesbetweenthehighfeverandthe

yeninpticemiaandmalaria.

larfever（不规贝U热）：influenzaorpticemia.

erythema/liverpalm（肝掌）:Thisisintenreddening,mottledinnature,ofthepalmer

inlyoverthethenarandhypothena大、小鱼际）

eminences.

angiomata（蜘蛛痣）:Spiderangiomataaresmallredmaculeswithfineredlinesradiati

ngfromitlike"spiderlegs".Theyblanchwhencompresd压之褪色）.Theyreprenttiny

dilatedcollateralbloodveslsandareeninpatientswithchronichepatitisorcirrhosis.

pha（窗口期）：Thewindowphaisthetimefromexposuretotheorganismuntilone

einthewindowphamaytestnegativebutactually

bepositiveandabletospreadtheorganism.

strain野毒株/街毒株）:itisreferredtorabiesvirusisolatedfromthenaturallyinfected

animalsorhumanwithstrongpathogenecityandlongincubationperiod.

train（固定毒株）:Afterbeingsubculturedinrabbitbrainformanytimes（atleast

50times）,thevirulenceofthestreetstraindecreadgreatly,butitsimmunogenicityremained.

Itiscalledfixedstrainandoftenudforvaccineproduction.

ody（内基本氏小体）：al

eosinoemost

consistenetlyeninthepyramidalcellsofhippocampusandPurkinjecellsofcerebellum.

emia（败血症）:Septicemiaisanacutegeneralizedinfectioncaudbytheinvasioninto

tayingpersistentlyand

multiplyingrapidlyinthebloodstream,theorganismsliberatetoxinsormetaboliteswhich

elicitgeneraltoxicsymptomsandtissuedamageofvariousorgans.

iemia（菌血症）：Thebacteriaenterthebloodandmultiplyinit,butstayonlyashorttime

anddon'tliberatetoxinsormetaboliteswhichelicitgeneraltoxicsymptomsandtissuedamage

ofvariousorgans.

（脓毒血症）：Themultiplyingsiteofbacteriaisalsointheblood,butitiscaudby

pyogenic（化脓性的）gram-positivecocci,metastaticlesionsarealwaysprent,thesymptoms

arethesameaspticemia.

a（毒血症）：Thebacteriaonlyliveandmultiplyinthelocalpartsofthebody,theydon't

enterthebloodstreamb,ptomsare

similartopticemia.

ots玫瑰疹）:Theyareblankingpinkmacularspots2-4mmindiameteratday7~13of

hisenmostcommonlyonthethoraxandabdomen,rarelyonbackand

theextremities.

vebradycardia（相目对缓脉）：ually

definedasincreainheartrate<10beats/minutes/C1increaintem°

usuallyenintyphoidfever,acuteschistosomiasis,verejaundice,etal.

imerreaction（赫氏反应）:Itiscaudasadirectresultofusingspirocheticidaldrugs

（mainlyantibiotics）totreatindividualswithaspirochetaldiawhichresultsin

anincreainthesymptomsofthetreatedcondition.

ticurinemicsyndrome/blackurinefever:Arious,oftenfatalcomplicationofmalaria,

characterizedbyanacuteintravascularhemolysis,

oftenprovokedbyantimalarialdrugs.

clesion（异位损害）:theschistosomeeggsand/oradultwormmigrateandparasitizethe

lativelyhighinlungand

brain.

renalsyndrome:Acuterenalfailureoccurringwithoutothercauinapersonwith

ney

structureremainsntiallynormalandthekidneysoftenwillinstantlyfunctionwelliftheliver

diaiscorrected.

'stest:Atestinvolvingagglutinationoftyphoidbacilliwhentheyaremixedwithrum

containingtyphoidantibodiesfromanindividualhavingtyphoidfever;udtodetectthe

phi.

Partn:Qustion.

emanifestationofinfection（感染过程的五种表现）

Pathogeniskilledoreliminated;

Covertinfectionorsubclinicalinfection,itisusuallythemostcommon;

Overtinfectionorclinicalinfection:thepathogenenterthehostandcauddamagesaswellas

uallyeasytoberecognizedinclinics.

Carrierstate:Itisaveryimportantsourceofinfection;

Latentinfection:itisusuallyeninherpesviridae,tuberculosis,malaria,etal.

describebrieflythefactorsinvolvedinthepathogenecityofapathogen（致病能力包括哪几个方面）?

Invasiveness:theabilityoftheagenttoenterandtomovethroughtissues;

Virulence:itisconsistsoftoxinsandothervirulentfactors;

Quantity:biggerquantity,strongerpathogenecityinthesamedia;

Variability:Thepathogenmaymutateunderthepressureoftheenvironmentorhost.

requisiteofanepidemicofacommunicabledia?（传染病流行的必要条件）

,theremustbeasourceofinfection

,theremustsomepersonswholackspecialimmunitytothedia,

ie,,thepathogenmustreachthesusceptible,therouteoftransmission.

iccharacteristicofcommunicabledia（传染病的基本特征）?

Themaindifferencebetweencommunicablediaandotherdiaisthattheformerhasfourbasic

muformer

haveinfectivity/communicability,municablediashavesome

tion,thereispost-infectionimmunitynomattercovertinfectionorovertinfection.

alcharacteristics/diagnosticcriteriaoffulminanthepatitis/hepatitisgravis（重型肝炎的诊断标准）?

Faracterizedbyrapidclinical

gnosticcriteriainourcountryis:

Severedigestivedisorder:poorfeeding,nauaandfrequentvomiting,fatigue;Progressivelydeepened

jaundice;

Hepatoencephalopathy;

Hepatorenalsyndrome;

Decreadvolumeofliver;

Bleedingpronenss;

Rapidlyincreadascites

alcharacteristics/diagnosticcriteriaofcholestatichepatitis？

Clinicalsymptoms:chis

canoccurontheneck,chest,back,olorbecomes

ghtherecanbemanysymptoms,thepatientusuallywillnotfeel

extremelyill.

Laboratorytests:Directbilirubinintherumelevatedanditsproportionismorethan60%ofthetotal

,GGT,

cholesterol,and5-nucleotidaareobviouslyelevated,andtheALTelevationismoderate.

B-Ultrasound:Itcandistinguishintraorextraliverobstruction.

/mainmanifestationofacuteviralhepatitis？

Malai,anorexia,fever,darkurine,palestools,jaundice,rightupperquadrantpainandtender

hepatomegaly;

Increadliverenzymes(ALT,AST),bilirubin,prothrombintimeandglobulin;

Serumpositiveforhepaticvirus;

Mayhavehistoryofrecentingestionofundercookedshellfishorwage-contaminatedwater.

nifestationofepidemicencephalitisB?

Thediaismainlymanifestedbyhighfever,impairmentofconsciousness,convulsion,

ofmeningealirritation,icalprocasofepidemic

encephalitisBislymphocyticpleocytosis,normalorslightlyelevatedproteinlevel,normalglucolevel,andelevated

cificIgMantibodydetectionismostufulforthediagnosisofthisdia.

ncipalofwoundtreatmentafterbittenbyarabiddog(被狂犬咬伤后伤口处理)?

Thewoundshouldbethoroughlycleandforhalfanhour,preferablywithaquaternaryammoniumdetergent(季

胺类消毒液)or20%soap(whichcannotbemixedtogether);thenrinwith70%ethanoloriodine;damagedtissues

canusuallybepreventediftreatmentisstartedwithinadayor

uldpayattentionto

tetanusandinfectionofotherbacteria.

nifestationofrabies/hydrophobia?

Thediabeginsasanonspecificillnessmarkedbyfever,headache,malai,naua,al

nsationsatoraroundthesiteofviralin

theprodromalperiodof2~4days,thecharacteristicfearofwater,responsibleforthealternativenameof‘hydrophobia

',andfearofwind,ons

andhallucinationsmaydevelopaccompaniedbyspitting,bitingand,andmaniacalbehavior,withlucidintervalsinwhich

nsues,

usuallywithinaweekfromtheontofsymptoms.

bebrieflythefivephaofhemorrhagicfeverwithrenalsyndrome.

TypicalcasofHFRSevolvein5stages:①thefebrilestagewithmyalgia,lasting3to4days;②thehypotensive

stage,oftenassociatedwithshockandlastingfromafewhoursto48h;③theoliguricphausuallylastsfrom3to7

ingconcentrationofbloodureaandcreatinineisaccompaniedbypersistentoliguria.④thediureticstage

withdiuresisandhyposthenuria;and⑤theconvalescentstage,gettingfullrecoverywithin1to6months.

nifestationofpeticemia

Themainclinicalmanifestationsofpticemiaarechills,highfever,veretoxemicsymptoms(suchasheadache,

dysphoria),petechia(瘀点)‘arthralgia(关节痛)，hepatosplenomegaly(肝脾肿大)，somepatientsmayhavemetastatic

(迁徙性)lesions;inverepatients,pticshock,toxiccerebrosis(脑病)，

toxicpneumonia,toxicmyocarditis(心肌炎),toxichepatitisandtoxicenteritis(肠炎)maybeprent

pointsofbloodculture

(1)beforeadministrationofantibioticsandduringchillsorhighfever；(2)repeatmorethan3times；(3)theamount

ofthebloodsampleshouldbe>10mlinadultsorolderchildren,>5mlininfants;(4)bloodsamplesshouldbetreated

withchemicalsifantibioticswasudbeforeorubloodclotforculture.⑸bonemarrowcultureisrecommended;⑹

drugnsitivitytestisverynecessary.

nifestationofepidemiccerebrospinalmeningitis

EpidemicencephalitisBisanencephalitiscaudbyflavovirus,

eaismainlymanifestedbyhighfever,impairmentofconsciousness,

convulsion,fmeningealirritation,increadintracranialpressureandotherneurological

icalprocasofepidemicencephalitisBislymphocyticpleocytosis,normalorslightlyelevatedprotein

level,normalglucolevel,cificIgMantibodydetectionismostufulforthe

diagnosisofthisdia.

euticprincipalsoffulminantmeningococcalmeningitis?

①ferreddrugispenicillin;②

anti-shocktherapy;③uofglucocorticoids(糖皮质激素)suchasmethylprednisoloneorDXM;④ifclinicalsigns

suggestcerebraledemaorthecerebrospinalfluidpressureisveryhigh,measurestoreducebrainswellingare

indicated;⑤anticoagulanttherapyifDICisprent;⑥supportivetherapytomaintainvitalorgans.

aracteristicoftyphoidfever

Typhoidfever,alsocalledentericfever,ischaracterizedbysustainedfever,gastrointestinalsymptoms,rospots,

relativebradycardia,hepatoslenomegaly,nicalcourofthedia

canbedividedinto4stages(:1)prodromalstage,(2)stageofprominentmanifestation,(3)remissionstage,and(4)

majorcomplicationsareintestinalhemorrhageandperforation,bothcanbe

life-threatening.

aracteristicofbacillarydyntery/shigellosis

shigellosisisanacutebacterialinfectioncaudbythegenusShigellaresultingincolitisaffectingpredominantly

aracterizedbyfever,diarrhea,abdominalpain,uallylimitedtoafew

reatmentwithantimicrobialdrugsresultsinmorerapidrecovery.

nifestationofcholera（霍乱）.

Choleraisanacute,sometimesfulminantwaterydiarrhealdiaresultingfromanenterotoxinelaboratedby

rallyoccursinepidemicsandmaycauarapidmassivegastrointestinal

fluidlosswithextremesalinedepletion,acidosis,andshock.

nifestationofleptospirosis（钩体病）

Leptospirosisisazoonotic（动物源的）diaofworldwidedistributioncaudbyspirochetes（螺旋

体）ofthegenus（种）videdintothreephasaccordingtoitsclinicalmanifestation:①theinitial

pha:leptospirabacteremia（钩体菌血症）;②thecondpha:organicinjuryanddysfunction;③thethirdpha:

tialclinicalsymptomsarefever,headache,myalgia（肌痛）,conjunctivalinjection（眼结

膜充血）andswellingoflymphnodes（淋巴结肿大）,insomecasfollowedbyamorevereillnessthatmayinclude

jaundice（黄疸）andrenalfailure,meningitis（脑膜炎）orhemorrhagicpneumonitis（出血性肺炎）.Intravenous

penicillinhasdemonstratedgoodclinicalefficacyforleptospirosis.

colitis/intestinalamebiasis（肠阿米巴病）.

Amebiasisiifestationofamebic

colitismaybesubtleorvereandrangefrommildwaterydiarrheatoexplosive,bloodydynterywithafulminant

colitismainlyprentswithlowerabdominalpain,milddiarrhea,malai,ols

containlittlefecalmaterialandconsistchieflyofbloodandmucus.

nifestationofhepaticamebiasis/amebicliverabscess（肝阿米巴病/阿米巴肝脓肿）.Amebicliverabscess

tsmaynoteright-upper-quadrantpainthatis

an50%ofpatientshavean

eaisfoundinlessthanone-thirdof

yrevealabdominaltenderness,tenderhepatomegaly,andcracklesat

ceisuncommon.

nifestationofmalaria（疟疾）

Thefirstsymptomsofmalariaarenonspecific,includingthelackofanofwell-being,fever,headache,fatigue,

ssic“trilogy”ofmalarialparoxysm（发作）includeschills,rigors,spikefever（体

温骤升骤降）,arum（恶性疟）,（间日

疟）,ae（三日疟）,cenlargementisverycommon.

Thediagnosisofmalinandthick

bloodsmearsshouldbeexamined.

requisitefortheepidemicofschistosomiasis（血吸虫病）.

theepidemicofschistosomiasisinanyspecificareaisdependentupontheunsanitarydisposaloffaeces,the

prenceofsuitablesnailhosts,andhumanexposuretocercaria-infected（尾蚴）waterbodies.

nifestationsofacuteschistosomiasis?

Themajorityofinfectedpersonareasymptomaticorhavemild,5to10percentof

cludechills,spikingfever,

generalizedweakness,myalgia,headache,anorexia,profudiarrhea,iveurticariamayoccur

feverusuallylysspontaneously2to10weeksafteront.

Physicalfindingsareusuallyminimalbutmanyincludeurticaria,patchesofmoistralesoverbothlungfields,

generalizedlymphadenopathy,elevationofperipheralbloodeosinophiliaiscom

mon..

alysisindication:

⑴Oliguriclasts>4d,oranuria>24h

⑵Concentrationofbloodureanitrogenandcreatinineincread:BuN>28.56mmol/l

⑶Highcatabolismstate⑷Hyperkalemia,

(5)Pulmonaryedemaorhypervolemicsyntrome

Stool

Meningococcal

meningitis

Purulent

cerobrosoinal

Tuberulous

meningitismenigitisEpidemicencephalitis

Toxic

Shigellosis

halitisBvirusShigelle

Ontabruptslowslowabruptabrupt

Age<10yearanyageanyage<10yearchildren

Season

Win.&Spr.

anytimeanytime

Sum.&Aug

Sum.&Aug.

Petechialcommonrarenonono

Earlyshockcommonrarenonocommon

meningeal

irritation++++-

BR:WBC

+++++++/-+++

N++++++-/++++

CSF:

WBC>1.0>1.00.05~0.30.05~0.5normal

Glucono

rmal

no

rmal

Chlorideno

rmal

no

rmal

J

J

entialDiagnnosisofEpidemicencephalitis

routi

ne

no

rmal

no

rmal

no

rmal

no

rmal

nDiffereneeBetweenG-SepticemiaandTyphoidFever

G"SeptiemiaTyphoidFever

Ontabruptlyinsidiouslyorslowly

ToxicSymptomsvereslight

GastrointestinalSymptomsldomobviously

SpecificToxicSymptomsldommaybeprent

ofCentralNervousSystem

Primarypticfocusmaybeprent(50%)no

DICmaybeprentno

Incipientpticshock40%patientsmayhaveno

Rashpetechiapredominantlyrospot

DifferentialCountneutrophilialymphocytosis

ofWBC

Widal'sReactionnegativepositive

BloodCulturecorrespondingpathogenstyphoidbacillus

nDifferencesBetweenG+cocciandG-BacilliSepticemia

G+CocciSepticemiaG-BacilliSepticemia

Ageyouthandmiddle-agedold-aged

Sexmalefemale

Generalhealthygoodpoor

conditionbefore

ont

ionofbiliary,intestinaland

Focus

incisionanddrainageofimmatureurinarytract,patientwithlivercirrhosis

abscess,tympanitisandosteomyelitis,ahistoryabdominaloperation

ClinicalSymptoms

obvious/markedchills,feve,joint

doublepeakfever,relativebradycardia

-

trouble,metastaticlesions

incipientpticshockandDIC,

BloodroutineleukocytosisnormalWBCorleukopenia

LLTnegativepositive

Treatmentgoodcurativeeffectcanbegainedwhengoodcurativeeffectcanbegained

usingtheantimicrobialagentsagainstwhenusingtheantimicrobialagents

G+cocciagainstG-bacilli

BloodCultureG+cocciG-bacilli

nDifferencesBetweenBacilliarydynteryandamebicdyntery

Bacilliarydynteryamebicdyntery

Incubationperioden

dotoxemiasymptoms

abodominaltenderness

diarrhea

Tenesmus

Predilectionsite

Stool::

veralhours-7days

usually(fever),obviousleft

lowerquadrantsashighas

20~40times/day+++—++++

rectosigmoidcolonpusand

blood

1-2weeks

ldomormild(fever)rightupperquadrant

veraltimes/day

(-)~(+)

appendicesandascendingcolon,bloody

stoolusuallyscantywithmucus

etiologyCulture:shigellaentamoebatrophozoites

volumesmalllarge

WBCmuchless

RBClessmuch

BloodWBC

normalorontf

Sigmidoscopicdiffuerythemawithflask-shapedulcerswithraid

Examinationsuperficialulcerdgesandnormalinterveningmucosa

Treatmentantibioticsanti-ameba

nDifferencesBetweenamebicliverabscessandbacterialliverabscess

amebicliverabscessbacterialliverabscess

historyamebiccolitispticemiaorabdominalpurulentdia

symptomontslow,long-termfever,rgent,toxemiasymptomsstriking

Liver:

enlargedliver,tendernessnotablemild

abscesssingle,large,many,small,

browncolourpusyellow-whitepus

entamoebatrophozoitesbefoundbacteriumculture:positive

BloodWBC,N

ffff

Bloodculturenegativepositive

Therapeuticrespongoodcurativeeffectcanbegainedgoodcurativeeffectcanbegained

whenusingheanti-amebaagentswhenusingtantibiotics

Prognosisrelativelygoodeasytorelap