Dengue fever.ppt
《Dengue fever.ppt》由会员分享,可在线阅读,更多相关《Dengue fever.ppt(33页珍藏版)》请在得力文库 - 分享文档赚钱的网站上搜索。
1、Denguefever報告者:PGY學員吳明政醫師指導醫師:吳冠達醫師台灣登革熱流行史台灣登革熱流行史台灣登革熱流行史台灣登革熱流行史典型登革熱其學名Denguefever,俗名天狗熱或斷骨熱,係由埃及斑蚊及白線斑蚊兩種病媒蚊傳播的急性病毒性熱疾,依血清抗原性分為1、2、3、4型,均具感染致病力。病毒必須藉由病媒蚊叮咬才能從人傳給人。造成登革熱/登革出血熱/登革休克症候群。蟲媒病毒,由黃病毒科(Flaviviridae)黃病毒屬(Flavivirus)中的登革病毒亞屬所引起。登革熱簡介病患從開始發燒的前一天直到退燒,此期間都具有病毒傳染力,此為登革熱病患之病毒血症期(viremia)。病媒蚊叮
2、咬登革熱病患815天後,則具有終生傳染病毒的能力。再次感染不同型別再次感染不同型別登革病毒,可能發生登革病毒,可能發生較嚴重的登革出血熱較嚴重的登革出血熱。登革熱簡介登革熱臨床症狀登革熱臨床症狀臨床症狀有些人感染到登革熱病毒並不會生病,稱為不顯性或無症狀感染,有些人僅有發燒等輕微症狀,有些人則出現較嚴重的典型症狀,包括發燒、紅疹、眼窩或發燒、紅疹、眼窩或骨頭酸痛,甚至出血現象骨頭酸痛,甚至出血現象。由於個人感染後表現之症狀有很大的差異,必須由醫師診斷或實驗室檢驗,因此懷疑感染疾病時就必須就診。一、典型登革熱1.潛伏期:58天(314天)2.前驅症狀:在發熱數小時至12小時前,可能有頭痛、厭食、
3、僵硬、違和、臉部潮紅。3.發熱:體溫驟然昇高至3940,而後持續56天。4.疼痛:在首24小時內,四肢酸痛、關節痛、肌肉痛、背痛、後眼窩痛、畏光。5.發疹:第3或第4病日,出現疹子,先發生在胸部、軀幹再擴散至四肢及臉部,有時會引起全身發癢。臨床症狀登革出血熱1.有發燒等典型病癥。2.出血性癥候:如止血帶試驗陽性,輕微或嚴重出血現象。3.血小板減少:血小板數目105/mm3。4.血液濃縮:血比容上升超過正常時20%,出現血管通透性明顯增加的證據,如低蛋白血症,胸膜或腹膜積水。1.有出血性登革熱病癥。2.低血壓,脈搏微弱至幾乎測不到,脈搏壓20mmHg。登革休克症候群HistoryFevernAb
4、ruptonset,risingto39.5-41.4CnAccompaniedbyfrontalorretro-orbitalheadachenLasts1-7days,thendefervescesfor1-2daysnBiphasic,recurringwithsecondrashbutnotashighRashnInitialrashtransient,generalized,macular,andblanching;occursinfirst1-2daysoffevernSecondrashoccurringwithin1-2daysofdefervescence,lasting1-
5、5daysnSecondrashmorbilliform,maculopapular,sparingpalmsandsolesnOccasionallydesquamatesBonepainnAbsentindenguehemorrhagicfever(DHF)/dengueshocksyndrome(DSS)nAfteronsetoffevernIncreasesinseveritynNotassociatedwithfracturesnMaylastseveralweeksnMostcommoninlegs,joints,andlumbarspineMiscellaneoussymptom
6、snNauseaandvomitingnCutaneoushyperesthesianTasteaberrationsnAnorexianAbdominalpain(severeinDHF/DSS)PhysicalFeverispresent.Rashisdescribedasfollows:nUptohalfofpatientswithdenguefeverdevelopacharacteristicrash.nTherashisvariableandmaybemaculopapularormacular.nPetechiaeandpurpuramaydevelopashemorrhagic
7、manifestations.Conjunctivalinjectiondevelopsinapproximatelyonethirdofpatientswithdenguehemorrhagicfever.Pharyngealinjectiondevelopsinalmost97%ofpatientswithdenguehemorrhagicfever.Generalizedlymphadenopathyisobserved.Hepatomegalyispresentmoreoftenindengueshocksyndromethaninmildercases.Hepatictransami
8、naselevelsmaybemildlyelevated.HemorrhagicmanifestationsincludethefollowingnPetechiaeandbleedingatvenipuncturesitesaremostcommon.nResultsfromatourniquettestareoftenpositive.Thistestisperformedbyinflatingabloodpressurecuffontheupperarmtomidwaybetweendiastolicandsystolicbloodpressuresfor5minutes.Theres
9、ultsareconsideredpositiveifmorethan20petechiaepersquareinchareobservedontheskinofthearm.nOtherhemorrhagicmanifestationsincludenasalorgingivalbleeding,melena,hematemesis,andmenorrhagia.DurationofillnessTheperiodofmaximumriskforshockisbetweenthethirdandseventhdayofillness.Thistendstocoincidewithresolu
10、tionoffever.Plasmaleakagegenerallyfirstbecomesevidentbetween24hoursbeforeand24hoursafterdefervescence.AlarmsignsSevereabdominalpain,persistentvomiting,abruptchangefromfevertohypothermia,orabnormalmentalstatus,suchasdisorientation,arenotedinaminorityofpatients.HematocritAnelevationofthehematocritisan
11、indicationthatplasmaleakagehasalreadyoccurredandthatfluidrepletionisurgentlyrequired.PlateletcountSeverethrombocytopenia(100,000/mm3)isoneoftheclinicalcriteriaforDHFandusuallyprecedesovertplasmaleakage.Serumaspartatetransaminase(AST)MildelevationsinserumtransaminasesarecommoninbothdenguefeverandDHF.
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- Dengue fever
限制150内