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1、 重庆医科大学临床学院教案及讲稿课程名称传染病学年级授课专业教 师职称授课方式学时 4题目章节Part 3 Chapter3 Malaria教材名称Lemology作者 Chief Editor :Liu Zhengwen出 版 社Xian Jiaotong University版次 2004 .11教学目的要求1.Etiology 2.Epidemiology 3.Features of Malaria 4.Diagnosis of Malaria 5.Treatment of Malaria 6.Preventl of Malaria 教学难点1Epidemic Process and T
2、he effect Factors。2Pathogenesis of Malaria。教学重点1. Definition2. Etiology 3.Epidemiology 4. Pathogenesis5. Clinical manifestation of Epidemic cerebrospinal meningitis 6. Complications7. Laboratory Findings 8. Diagnosis and Differential Diagnosis of Epidemic cerebrospinal meningitis 外语要求English Languag
3、e教学方法手段Classroom lectures and multimedia参考资料1、15th Edition Mandell,Douglas and Bennetts Principales and Practice of Infectious Diseasea.Vol-2, 2001 edited by Gerald L.Mandell,Jone E.Bennett,Raphael Dolin, publishing by Harcourt Ansia and Churchill Livingstone.2、4th Edition Kelleys Textbook of Intern
4、al Medicine 2004 edited by H.David Humes, publishing by Lippincott Williams & Wilkins Inc.教研室意见 教学组长： 教研室主任：年 月 日 Time arrangement 一、Definition 15MinMalaria is a parasitosis caused by plasmodia.It is transmitted to human by the bite of mosquito. Clinical feature: cyclic chill, high fever & profuse s
5、weating. In chronic illness, there are anemia & splenomegaly.二、Epidemiology 25MinTachysporozoiteBradysporozoiteMerozoiteSporozoiteParasitemiaTow period: human - whole asexual reproductionmosquito - sexual parasitic stage Two host:human - intermediate hostmosquito - final host notes:clinical symptoms
6、: erythrocytic stagerelapse: exerythrocytic stageinfectivity: sporozoite 三、Epidemiology 20Min Source of infection： Patient, parasite carrierRoute of transmission female mosquito biting personblood transfusionSusceptibility:universal susceptibilityno-cross-immunityre-infectionEpidemic features: spora
7、dic or endemic, tropic or subtropic 四、Pathogenesis 20MinMechanism of attack P. Faciparam: produce microvascular diseasemagnitude of the parasitemia & age of patientno specific Ab or cell -mediated responseAnemia:P. Vivax - retiform RBCP. Malariae - mature RBCP. Falciparum - every RBCProlifeation of
8、mononuclear phagocytehepatomegalysplenomegalyCerebral edema & congestion五、Clinical manifestation 20Min Incubation period: quartan malaria: 24-30 day tertian malaria: 1315 day malignant malaria: 712 dayTypical attackChill: abrupt onset, shivering, pale face,cyanosis. Last 10 min or 12hr.High fever: T
9、 rise to 40oC with malaise, myalgia, thirsty. Last 26 Hr.Sweating: profuse sweating with restlessnessregular 48 hr. or 72 hr. CycleSingsanemiasplenomegalyhepatomegaly, ALT elevatePerniciouse attack: cause by P. Falciparumcerebral malariahigh fever, headache, vomiting, convulsion delirum, respiratory
10、 failurehyperpyrexia typeT 420C, convulsion, deliriumRelapse: early relapse - 6m Malaria caused by transfusionincubation period: 710 dayno exerythrogenic phase, no relapse六、Complications 20MinBlack- water- fever:cause:1/inadequate G-6-PD 2/The toxin release by malarial parasite3/Allergic reaction to
11、 anti-malarialdrugsfeature:1/chill & fever2/dark red or black urine3/severe hemolytic anemiaAcute glomerulonephritis七、Laboratory Findings 20Min Blood picture: decrease in RBC & Hb blood film for parasiteserological examinationELISA for P. antigenDNA hybridization八、Diagnosis and Differential Diagnosi
12、s 10Min Epidemiological dataendemic zoneblood transfusionClinical manifestationLaboratory findingsDiagnostic treatment:chloroqunine for 3 daysTyphoid feverSepticemiaLeptospirosisEncephalitis B九、Treatment 10Min Anti-malarial drugs Chloroquine-susceptable infectionchloroquine : 1g /d, for 3 day, p.o.p
13、rimaquine: for 8day, p.o. Chloroquine-resistant infectionmefloguine:artemisininePernicious attackChloroquine: 10mg/kg iv drop in 4 hr. Then 5mg/kg, iv drop in 2 hr.Quinine: 500mg iv drop in 4 hr.Radical therapy Chloroquine (3 day) + primaquine ( 8 day) 辅助手段：同步播放多媒体课件 时间分配：见教学内容小结Malaria is a parasitosis caused by plasmodia.It is transmitted to human by the bite of mosquito. Clinical feature: cyclic chill, high fever & profuse sweating. In chronic illness, there are anemia & splenomegaly.思考
