Syllabuses
Researchers Reveal the Secrete of Nonrandom DNA Seg-regation in Human Cells
Syllabus & Outline
COMMUNICABLE DISEASES
Department of Infectious Diseases,
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
First Affiliated Hospital,
Syllabus of Communicable Diseases
Course Number: 18120040
Prerequisites: Basic Medical Courses
Credits (hours per week, Lecture/Practical): 2 (1.5-1)
Year: 4th year 2nd semester
OBJECTIVES:
“Communicable diseases” is an important course of clinical medicine. It belongs to internal medicine system and is closed associated with microbiology, parasitology, immunology, epidemiology, internal medicine, pediatrics and so on. However, it has its own particularity. Teaching of “communicable diseases” should make the students master the theoretical knowledge and essential clinical techniques of infectious diseases. That will be benefit to the medical work after their graduation.
1. Essential theory, essential knowledge and essential technique
(1) Teach the general introduction of infectious diseases in class, make the students master the essential theories about the characters of infectious diseases, definition of infectious diseases, the manifestation of infectious process, the epidemic process and influencing factious of infectious diseases, the essential characters and clinical features of infectious diseases, the diagnostic measures and therapy of infectious diseases, the prevention of infectious diseases and so on. The students should master the etiology, epidemiology, pathogenesis, pathological change, clinical manifestation, laboratory findings, complications, diagnosis, differential diagnosis, treatment and prevention of 15 common infectious diseases through the class teaching.
(2) Through class teaching, teaching on probation and practice, the students should learn how to make a summary of a case, give the diagnosis and differential diagnosis, make a plan of treatment, further examination based on the essential theories of infectious diseases.
(3) The students should learn how to collect the illness history, body check, writing history report and make an initial diagnosis and therapeutic plan, writing the progress notes, and master some common medical techniques like lumbar puncture, thoracentesis, abdominal paracentesis, bone marrow aspiration by studying on probation and practice of infectious diseases.
2. Culture the students’ capability
(1) Culture the capability of self-study: Combining the problems from clinical practice, guide the students to look up the related reference, journals, and textbook. Teach them the methods of self-study and enhance their capability of self-study.
(2) Culture the capability of clinical analysis: During the probation and practice of infectious diseases, teach the students how to consider the clinical problems through clinical rounds, case demonstration and case discussion. Try to enhance the students’ capability of clinical analysis.
(3) Culture the independent capability of dealing with clinical problems: In the clinical practice, the students should learn to write the case history, prescribe the medical order, write the case progress note and do some common operations with the guidance of the teachers. Culture the independent capability of dealing with clinical problems.
COURSE CONTENT:
Teaching in class
Section 1 General introduction of infectious diseases ----------- 3 teaching periods
Section 2 Viral hepatitis ------------------------------------------- 3 teaching periods
Section 3 AIDS ----------------------------------------------------- 3 teaching periods
Section 4 Epidemic influenza ------------------------------------ 3 teaching period
Section 5 Epidemic encephalitis B ------------------------------ 2 teaching period
Section 6 Epidemic cerebrospinal meningitis------------------- 1 teaching period
Section 7 Typhoid fever and paratyphoid fever----------------- 3 teaching period
Section 8 Cholera ------------------------------------------------- 3 teaching periods
Section 9 Malaria -------------------------------------------------- 3 teaching periods
Practicals
The clinical posting content is designed to complement the lectures. The practicals include clinical probation (16 teaching periods) and clinical practice (2 weeks). The students should master the skill of physical examination of lymph node, liver, spleen, ascites, jaundice, rash, etc. Medical history taking is important in diagnosis of infectious disease.
STRUCTURE:
Teaching of communicable diseases can be divided into three phases, including teaching the theoretical knowledge in class, clinical probation and practice. The total time is 40 teaching periods. Teaching in class and clinical probation share 24 and 16 teaching periods respectively. The final examination (2 hr) will be multiple-choice answer.
ORGANIZATION:
Each session will be offered to the entire class.
An assistant will act as liaison between students and teachers, and will be responsible for taking attendance, collecting exam papers, and related matters.
EVALUATION:
Students’ performance will be evaluated on the basis of attendance at lectures (15%) and participation in practicals (15%), and scores on test (70%).
RECOMMENDED TEXTBOOK:
1. Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases, 6th ed.
2. Southwick FS. Infectious Diseases in 30 Days. McGraw-Hill Companies, Inc. ISBN 0-07-137518-X. 2003.
TEACHING TEAM:
Faculty:
Prof. RUAN Bing
Email: ruanbing@zjwst.gov.cn Tel: 13858182230, 0571-87236585
Prof. WO Jianer
Email: wojianer@zju.edu.cn
Prof. WU Nanping
Email: flwnp@yahoo.com.cn
Prof. YANG Yida
Email: yangyida65@163.com
Prof. XIANG Chunsheng
Email: charlie20892@yahoo.com
Associated Prof. LI Jun
Email: lijun918@gmail.com
Associated Prof. ZHENG Min
Email: minzheng@zju.edu.cn
Associated Prof. YANG Qian
Email: yangxian@hz.cn
Assistant:
Assistant Prof. JIA Hongyu
Tel: 13157189456
Email: jia-hy@yeah.net
Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital,
Outline of Communicable Diseases
Direction for use
1. This teaching outline offers the reference to the teachers. It can help the teachers to learn the principle knowledge and requirement of every section in the textbook. That can help the teachers give priority to key in class.
2. This teaching outline can be the guidance for the students. It can help the students to know the primary and secondary knowledge of every disease and master the principle knowledge.
The teaching outline of “communicable diseases” divides the knowledge of infectious diseases into three levels, including “master”, “learn” and “understand”.
Section 1 General introduction of infectious diseases
Teaching time: 3 periods
Objective and requirement:
⑴ Master: The definition of infection and infectious diseases. Five types of manifestation during infection. Four principle features of infectious diseases. Three essential steps of the epidemiology of infectious diseases. The clinical feature of infectious diseases.
⑵ Learn: The laboratory examination and diagnosis of infectious diseases. Therapy and prevention of infectious diseases.
⑶ Understand: The role of pathogen in the process of infection. The role of immune response in the process of infection. The onset and development of infectious diseases. The pathogenesis of the injury of the tissue. The important pathological change.
Teaching knowledge:
1. Infection and immune
(1) Definition of infection and infectious diseases.
(2) The five types of manifestation during the process of infection: elimination of the pathogen; covert infection; overt infection; carrier; incubation infection.
(3) The role of pathogen in the process of infection: invasiveness, virulence, quantity, variability.
(4) The role of immune response in the process of infectious disease. The immune response can be divided into two types. One is the protective immune response against the invasion of pathogens, including the non-special immune response and special immune response. The other is the allergic response (special immune response) enhancing the pathogenesis and the damage of the target organ.
2. The pathogenesis of infectious diseases.
(1) The onset and development of infectious diseases. The invasive entry, location, excretion of the pathogens.
(2) The pathogenesis of the damage in organs: direct invasion, the effect of the toxin and the immune pathogenesis of infectious diseases.
(3) The important pathological change.
3. The epidemiological process and affected factors of infectors.
(1) The three key essential steps of the epidemiology of infectious diseases, including the source of infection (patients, pathogen carriers and infected animals), transmission route (spread through air, water, food, contact, insect and soil) and susceptibility.
(2) The factors influencing the epidemiological process (environmental factors and social factors).
4. The feature of infectious diseases
(1) The four essential features of infectious diseases: pathogen, infectivity, epidemiological features (epidemicity, endemicity and seasonality), immunity after infection.
(2) The clinical features of infectious diseases: the regularity of the process of infectious diseases: incubation period, prodromal period, period of apparent manifestation, convalescent period. Pyrexia and fever type. Multiple rashes and enanthema. Toxemia, hepatomegaly and splenomegaly.
5. Diagnosis of infectious diseases
(1) The diagnosis of infectious diseases: the diagnosis should be based on the epidemiological data, clinical data, laboratory findings and other results of examination.
(2) Laboratory examination: Smear and isolation (culture) of pathogen; the identification and susceptibility test of pathogen; immunological technique, including radioactive immunoassay, ELISA, fluorescent immuno-assay, hybridoma technique and gas chromatogram; gene examination.
6. Therapy of infectious diseases. The key therapies of variable infectious diseases.
(1) The essential combined therapy is the most important. The special therapy of infectious diseases is etiological treatment.
(2) The significance of general and symptomatic therapy for infectious diseases; maintain the function of the important organs; retrieve the shock and the disorder of water and electrolytes; enhance the patient’s immunity and regulate the immune function.
(3) Rehabilitation treatment.
(4) Chinese traditional medicine.
7. Prevention of infectious diseases
(1) Management of the source of infection (Law of infectious diseases, the classification of infectious diseases, the reporting system of infectious diseases, isolation of patients and pathogen carriers).
(2) To cut the transmission route and protect the susceptible population.
(3) The special and non-special immunological method of prevention.
Teaching methods: To give a lecture with multimedia and powerpoint.
To demonstrate the disease with the typical cases.
Section 2 Viral hepatitis
Teaching time: 3 teaching periods
Objective and requirement:
⑴ Master: the features of the pathogen and the system of antigen and antibody. The clinical significance of viral nucleic acid. The clinical manifestation of each type of viral hepatitis. The diagnosis and differential diagnosis of viral hepatitis. The essential therapeutic principles. The preventive measure.
⑵ Learn: Epidemiology; the pathogenesis and pathological change of viral hepatitis.
⑶ Understand: The pathological feature of viral hepatitis. The prognosis of viral hepatitis.
Teaching knowledge:
1. Pathogen:
(1) The types of viral hepatitis and their systems of antigen and antibodies.
(2) The antigens and antibodies system of hepatitis B virus. The subtypes of hepatitis B and its clinical significance. The examination of HBV DNA and its clinical significance.
(3) The genome structure of hepatitis C virus. The mutation of hepatitis C virus. The examination of HCV RNA and its clinical significance.
(4) Hepatitis D virus and its nucleic acid. Its system of antigens and antibodies.
2. Epidemiology: the source of infection, transmission route and susceptible population of hepatitis A, B, C, E. The epidemiological features.
3. The pathogenesis and pathologic physiology of viral hepatitis.
(1) Pathogenesis.
(2) The pathological features of viral hepatitis.
(3) The pathogenesis and pathologic physiology of jaundice, ascites, hemorrhage and hepatic encephalopathy.
4. Clinical manifestation:
(1) The clinical features of viral hepatitis classified by pathogens. Viral hepatitis A and E can lead to acute hepatitis but never chronic hepatitis. Viral hepatitis B, D and C usually cause chronic hepatitis.
(2) The clinical manifestation and physical signs of all clinical types of hepatitis. The clinical features of acute hepatitis, chronic hepatitis, liver failure, post-hepatitis liver cirrhosis and cholestatic hepatitis.
(3) The prognosis of viral hepatitis.
5. Diagnosis and differential diagnosis.
(1) The diagnosis of hepatitis (epidemiological data, clinical manifestation, examination of liver function and pathogen).
(2) The laboratory diagnosis and clinical significance of hepatitis (examination of pathogen: examination of the serum markers and molecular biology; biochemical examination, including ALT, AST, GGT, ALP, ALB, GLB, TB and DB; the significance of PTA for the diagnosis of liver failure).
(3) Differential diagnosis: the differential diagnosis of jaundice (hemolytic jaundice and obstructive jaundice); the differential diagnosis with the diseases leading to hepatic jaundice.
6. Therapy of hepatitis
(1) The essential therapeutic principle.
(2) The combined basal treatment, including the control of food and behavior, avoidance of the factors resulting to liver damage, the proper choice of the drugs, the important role of symptomatic treatment and supportive treatment.
(3) Anti-viral treatment of chronic hepatitis.
(4) The therapeutic principle of liver failure and the treatment of complications. It is important for the combination of artificial liver support system (ALSS) and basal treatment to make the dead rate of liver failure decrease.
7. The prevention of viral hepatitis.
(1) The combined measures for prevention;
(2) Passive immunologic prevention (the application of immune globulin);
(3) Active immunologic prevention (the successful application of the vaccines against viral hepatitis A and viral hepatitis B ).
Teaching methods: To give a lecture with multimedia and powerpoint.
To demonstrate the disease with the typical cases.
Section 3 Acquired immunodeficiency syndrome (AIDS)
Teaching time: 3 teaching periods
Objective and requirement:
⑴ Master: The epidemiology of AIDS; the clinical manifestation of AIDS; the diagnostic methods of AIDS.
⑵ Learn: The pathogenesis of AIDS; the therapeutic principle of AIDS; the preventive measures of AIDS.
⑶ Understand: the features of AIDS’ pathogen: HIV is a kind of retrovirus. The morphous and gene structure of HIV.
Teaching knowledge:
1. Etiology: HIV belongs to retroviruse. The morphous and gene structure of HIV. The classification and feature of HIV.
2. Epidemiology
(1) The source of infection includes patients and the virus carriers without any symptoms.
(2) The principle transmission route: (sex transmission, polluted injection, blood transmission, mother-to-baby transmission); the difference and similarity between the developed country and the developing country.
(3) The high risk population. The susceptible age.
(4) The current epidemic states in different regions.
3. Pathogenesis
(1) The injury of the immune system: the ratio of CD4+/CD8; mononuclear macrophage; the injury of B lymphocyte; the injury of neurocyte.
(2) The injury mode of CD4+T lymphocyte and the related manifestation (the change of the quantity and quality of the immunocytes ). Opportunistic infection and tumor.
(3) Pathological change: the pathological change of the lymph nodes; the pathological change of the central nervous system.
4. Clinical manifestation: the stages of the illness and the principle manifestation of each stage.
(1) Acute infection: incubation period, symptoms and physical signs.
(2) Infectious stage without any symptoms: the persisting time.
(3) The persistent generalized lymphodenpathy and AIDS period: the symptoms and physical signs, persistent time.
(4) The related clinical manifestation of the common involved systems.
(5) The common opportunistic infection and tumor in AIDS.
5. Diagnosis
(1) Epidemiological data;
(2) Clinical manifestation;
(3) Laboratory findings (The diagnostic significance of special antibody, CD4/CD8, virus isolation and HIV RNA);
(4) The standard of the definitive diagnosis.
6. Therapy
(1) Anti-viral therapy (the current principle protocols and drugs of anti-viral therapy; the proper time for the anti-viral therapy; combined treatment);
(2) Therapy of enhancing immunity.
(3) Supportive and symptomatic treatment;
(4) Chinese traditional medicine;
(5) Treatment of HIV related diseases and opportunistic infection.
7. Prevention
(1) Health teaching; the survey of the high risk population. The measure and significance of cutting the transmission routes. Personal protection.
(2) Policy and law.
Teaching methods: To give a lecture with multimedia and powerpoint.
To demonstrate the disease with the typical cases
Section 4 Epidemic influenza
Teaching time: 3 teaching periods
Objective and requirement:
⑴ Master: The clinical manifestation of epidemic influenza; the laboratory findings of epidemic influenza; the diagnostic evidence of epidemic influenza. The pathogen, clinical manifestation, diagnosis and therapy of avian influenza.
⑵ Learn: The pathogenesis of epidemic influenza. The epidemiological features of epidemic influenza; the differential diagnosis of epidemic influenza; mutation of influenza virus.
⑶ Understand: Etiology; the features of influenza virus; the types and subtypes of influenza virus; the prognosis of influenza virus.
Teaching knowledge:
1. The features of influenza virus
(1) The ascription and morphous of influenza virus: a kind of Orthomyxovirus; RNA virus.
(2) The structure and features of the influenza virus: the antigens of neucleoprotein and outer membrane protein are stable and have specificity of viral types. The outer layer is lipid and has two particles, including hemagglutin and neuraminidase. Their antigens are not stable and have specificity and immunity of viral subtypes and viral mutation.
(3) The types and subtypes of influenza virus: Influenza virus can be divided into type A, B and C according to the antigenicity of neucleoprotein. Each type of influenza virus can be further divided into some subtypes based on the surface antigen and the antigens of hemagglutin and neuraminidase.
(4) The variability of influenza virus: The mutations of influenza virus A include group mutation, subtype mutation and species mutation. Influenza virus B only has species mutation. It has not been found any mutation in influenza virus C.
2. The epidemiological features and preventive measure.
(1) Source of infection: patients and covert infectors.
(2) Transmission route: droplet infection.
(3) Susceptible population: Cross immunity against the mutation of the infected subtype virus is produced after infection.
(4) Epidemiological features: Influenza A usually causes epidemic outbreak, small epidemic, pandemic and even global pandemic. Influenza B can cause epidemic outbreak or small epidemic. Influenza C always occurs sporadically.
3. Pathogenesis
(1) Usually no viremia. Influenza virus invades the ciliated columnar epithelial cells and replicates in them. The viruses are set free from the cells with the help of neuraminidase, and then invade other cellula columnoepithelialis, leading to degeneration, necrosis and exfoliation.
(2) The macropathological features of primary pneumonia caused by influenza virus and secondary infection of pneumonia.
4. Clinical manifestation
(1) Clinical features: the respiratory symptoms are mild while the toxic symptoms like fever and fatigue are serious.
(2) Clinical manifestations of the typical influenza.
(3) Clinical manifestations of influenza of mild type, pneumonia caused by influenza virus, pneumonia caused by secondary bacterial infection.
5. Diagnostic evidence
(1) Epidemiological data.
(2) Typical clinical manifestation.
(3) Laboratory findings:
Virus isolation: The rinse water from oropharynx and pharyngeal swab within first 3 days of the illness get inoculated in the chick embryo culture. Quick diagnosis: Impression preparation of nasal mucous membrane and fluoresce in antibody technique.
Serologic diagnosis: Hemagglutination inhibition test and complement fixation test are made in the serum samples from the early period and 2~4 weeks after the onset of the illness.
(4) Differential diagnosis: Other viral infection in respiratory tract, acute tonsillitis, leptospirosis and so on.
6. Therapy
(1) Drinking more water and rest in bed in the febrile phase.
(2) Chinese traditional medicine.
(3) Patients with fever can be treated with antipyretic analgesic like aspirin.
(4) Antibiotic can be used for infant and the elder to prevent secondary bacterial infection.
7. Preventive measure: Survey of the epidemic situation; isolation of the patients; disinfection; vaccination; Chinese traditional medicine.
Etiology, clinical manifestation, diagnosis and therapy of avian influenza.
Teaching methods: To give a lecture with multimedia and powerpoint.
To demonstrate the disease with the typical cases
Section 5 Epidemic encephalitis B
Teaching time: 2 teaching periods
Objective and Requirement:
⑴ Master: Clinical manifestation; Laboratory examination; Evidence of diagnosis; Therapy
⑵ Learn: Pathogenesis; Feather of epidemiology; Differential diagnosis.
⑶ Understand: Etiology, including the feature of the virus; Prognosis; Complication; Sequela; Symptoms in convalescent period.
Teaching knowledge:
1. Etiology: Features of the virus: a type of arboviruses.
2. Pathogenesis: The position where the virus invade the human body; viremia for twice; the change of the cellular immunity.
The way that the viruses attack the central nervous system.
The location with pathological change; pathological change in vessels; degeneration and necrosis of neurocyte; proliferation of glial cells and infiltration with inflammatory cells.
3. Epidemiology
⑴ Zoonosis: The pigs, especially the young pigs, is the principle source of infection.
⑵ Spread through the bite of mosquitoes: The Culex tritaeniorhynchus is the principle transmission vector.
⑶ Epidemiologic feature: Seasonality: this disease usually occurs in Summer and Autumn. The children, especially under the age of 10, are the principle victims.
4. Clinical manifestation.
(1) It is an acute infectious disease in central nervous system with the inflammatory mainly involved in the brain.
(2) Four periods of the illness: Incubation period, early period, fastigium period and convalescent period.
(3) The important manifestation in fastigium period: High fever, disturbance of the consciousness; twitch, respiratory failure; sometimes the pathological reflex and the signs of meningeal irritation may be positive.
(4) Clinical classification: Mild type, common type, serious type, severe type.
5. Laboratory findings:
(1) Blood routine;
(2) Cerebral spinal fluid;
(3) Serological examination: the examination of the special IgM antibody.
(4) Isolation of the virus.
6. Evidence for diagnosis
(1) Epidemiologic data: Seasonality (summer and autumn), mostly occurs to children under the age of 10.
(2) The symptoms and physical signs include acute onset, high fever, headache, vomiting, disturbance of consciousness, twitch, respiratory failure, pathological reflex, signs of meningeal irritation.
(3) Laboratory findings show elevation of WBC and leukocyte, change of cerebrospinal fluid like serofluid. Serological examination can help definitive diagnosis.
(4) Differential diagnosis: Ekiri, viral encephalitis caused by other viruses, tubercular meningitis, purulent meningitis.
7. Therapy and prognosis
(1) No effective anti-viral drug. Symptomatic treatment and intensive care are necessary. The key treatment is to deal with the three dangerous symptoms, including high fever, twitch and respiratory failure.
(2) Prognosis: Complication, sequela and the manifestation in convalescent period.
8. Prevention: Control and manage the source of infection, kill out the mosquitoes and avoid being bitten by mosquitoes, vaccination.
Teaching methods: To give a lecture with multimedia and powerpoint.
To demonstrate the disease with the typical cases
Section 6 Epidemic cerebrospinal meningitis
Teaching time: 1 teaching period
Objective and requirement:
⑴ Master: the clinical manifestation of epidemic cerebrospinal meningitis; the diagnostic evidence of epidemic cerebrospinal meningitis and the etiologic therapy.
⑵ Learn: Epidemiology of epidemic cerebrospinal meningitis; the relationship between pathogenesis and clinical manifestation.
⑶ Understand: the features of Neisseria meningitdis; the principle preventive measure.
Teaching knowledge:
1. Etiology
(1) The feathers and classification of the pathogen.
(2) The problem about drug resistance.
2. Epidemiology
(1) Source of infection (patients and carriers)
(2) Transmission route
(3) Susceptible population (diversify the people’s immunity and periodical epidemic of the microbial population).
3. Pathogenesis
(1) The process of infection in the pharynx nasalis, bacteremia and purulent inflammatory of the meninges.
(2) The pathogenesis of fulminate type of this disease: DIC, cerebral edema and cerebral hernia.
4. Clinical manifestation
(1) Incubation period, clinical types;
(2) Manifestation of typical type; meningeal irritation sign; petechia;
(3) The manifestations of all types of the fulminate types.
5. Diagnostic evidence
(1) Epidemiological data;
(2) Principle clinical manifestation;
(3) Examination of the cerebral spinal fluid (CSF);
(4) Bacteria examination (smear of the throat swab, CSF and petechia);
(5) Differential diagnosis among epidemic cerebrospinal meningitis and other purulent meningitis, tubercular meningitis, Japanese encephalitis, viral meningocephalitis and toxic dysentery.
6. Therapy
(1) General symptomatic treatment;
(2) Etiologic treatment: choice of antibiotic; the treatment of fulminate type of epidemic cerebrospinal meningitis.
7. Prevention: the principle preventive measure.
Teaching methods: To give a lecture with multimedia and powerpoint.
To demonstrate the disease with the typical cases
Section 7 Typhoid fever and paratyphoid fever
Teaching time: 3 teaching periods.
Objective and requirement:
⑴ Master: Pathogenesis of typhoid fever, the relationship between the pathological feature and clinical manifestation. The clinical manifestations in 4 phases of the typical type of typhoid fever. The principle complications of typhoid fever. The evidence for diagnosis of typhoid fever and the differential diagnosis. pathogenic treatment.
⑵ Learn: Epidemiology of typhoid fever. Relapse and recrudescence. The clinical manifestation, diagnosis and therapy of paratyphoid fever.
⑶ Understand: The feature of Bacterium typhi, including the living characters, resistance, antigen. The principle way to prevention.
Teaching knowledge:
1. The character, resistance and antigenicity of bacterium typhi.
2. Epidemiology:
⑴ Source of infection (the epidemiologic significance of the patient, carrier and chronic carrier)
⑵ Transmission route (Water, food, daily contact)
⑶ Susceptible population and persistent immunity after infection.
⑷ Epidemiologic feature.
3. Pathogenesis and pathological feature.
⑴ The way by which the pathogen invade the human body. Bacteremia for twice.
⑵ The principle pathologic change is the productive reaction of the mononuclear phagocytic system, especially the lymph tissue in the inferior segment of the ileum.
⑶ The relationship among pathogenesis, pathological change of intestine and clinical manifestation.
1. Clinical manifestation
⑴ The four phases of typhoid fever. The clinical manifestation in fastigium period. The relationship between fever type and the course of the illness. The principle complication.
(2) Relapse and recrudescence.
(3) Clinical type. The feature of children patients and aged patients with typhoid fever.
5. Laboratory findings
(1) Blood routine: diminution of WBC, diminution and even disappearance of eosinophils.
(2) The diagnostic significance and assessment of Widal reaction.
(3) Culture of pathogen: the proper time and value of the pathogenic culture from blood, bone mallow and stool.
6. Diagnosis and differential diagnosis
(1) The principle evidence for clinical diagnosis and the necessary evidence for definitive diagnosis.
(2) Differential diagnosis with other diseases characterized by fever.
7. Therapy: General treatment: Intensive care and foodintake; pathogenic treatment (the choice of antibiotic, the first choice is Quinolone of the third generation); treatment of the complications; treatment of the carriers.
8. Prevention: The principle way to prevention
9. The principle clinical manifestation, diagnosis and therapy of paratyphoid fever.
Teaching methods: To give a lecture with multimedia and powerpoint.
To demonstrate the disease with the typical cases
Second 8 Cholera
Teaching time: 3 teaching periods
Objective and requirement:
⑴ Master: the clinical manifestation of cholera; the diagnosis and differential diagnosis of cholera; therapy of cholera.
⑵ Learn: Epidemiology.
⑶ Understand: the feature of etiology, preventive measure.
Teaching knowledge:
Cholera is a drastic enteric infectious disease caused by cholera bacillus. It has acute onset and spread rapidly. The manifestation can be mild or serious. It is an international quarantinable disease and belongs to the A type of infectious diseases according to the law of the prevention and therapy of infectious diseases in our country.
1. Etiology: the biological features of cholera bacillus; three serotypes.
2. Epidemiology
(1) Epidemiologic history of cholera: global pandemic for 7 times.
(2) Epidemiologic steps: source of infection (patients and carriers); transmission route (digestive transmission, mainly by water transmission) and susceptible population.
(3) Epidemiologic features: endemicity, foreignness and seasonality.
3. Pathogenesis
(1) The mechanism of cholera enterotoxin;
(2) pathophysiology: severe vomiting and diarrhea cause the loss of large amount of water and electrolyte, resulting in dehydration, peripheral circulatory failure, Hypokalemia syndrome, metabolic acidosis and so on.
(3) Pathological change: mainly caused by dehydration. It can completely recover with prompt effective treatment.
4. Clinical manifestation of cholera
(1) Incubation period. The stages of the illness include vomiting and diarrhea period, dehydration period and response period.
(2) Clinical features of each clinical types, including mild type, moderate type, severe type and fulminate type.
(3) Laboratory finding: No special change in stool routine. The biochemical examination can help surveying the change of the illness. The etiologic examination can help the definitive diagnosis.
5. Diagnosis of cholera
(1) Epidemiological data;
(2) Features of the clinical manifestation;
(3) Etiologic examination: bacterium examination (stool hanging drop and staining, examined in microscopy). The stool culture is significant for the definitive diagnosis. Serological examination can help the diagnosis for the patients with negative findings of stool culture.
(4) Standard of the definitive diagnosis and suspicious diagnosis.
(5) The differential diagnosis of cholera: bacterial food poisoning, acute shigellosis, diarrhea caused by the enterotoxigenic E. coli, arsenic poisoning and so on.
6. Therapy of cholera
(1) Strict isolation;
(2) The importance of fluid replacement therapy. Master the fluid replacement therapy, including the types, doses, speed of fluid replacement. The indication, type of fluid, prescription, dose of oral rehydration,
(3) Antibiotic: aiding role of the therapy.
7. Preventive measure: management of the source of infection, report the epidemic situation in time. The management of the patients and the people with close contact with patients. Cut the transmission route: “three management and one elimination”: to manage the drinking water, food and stool and eliminate the flies; protect the susceptible population; preventive vaccination.
Teaching methods: To give a lecture with multimedia and powerpoint.
To demonstrate the disease with the typical cases
Section 9 Malaria
Teaching time: 3 teaching periods
Objective and requirement:
⑴ Master: the clinical manifestation of malaria; the diagnostic evidence and differential diagnosis of malaria; treatment of malaria.
⑵ Learn: the pathogenesis of malaria; epidemiology.
⑶ Understand: the relationship between the life cycles of four plasmodiums, onset of the illness, recrudescence and transmission. Preventive measures.
Teaching knowledge:
1. Etiology: the relationship between the life cycles of four plasmodiums, onset of the illness, recrudescence and transmission.
2. Epidemiology
(1) Source of infection: Patients and plasmodium carriers.
(2) Transmission route: spread through the bite of transmitting vectors.
(3) Susceptibility.
(4) Epidemiologic features: endemic epidemic, seasonality: summer and autumn.
3. Pathogenesis
(1) The principle of the onset of malaria;
(2) The principle pathological change: anemia, proliferation of endothelial system, hepatomegaly, splenomegaly, change of the brain.
4. Pathogenesis
(1) Incubation period;
(2) The outbreak course of typical malaria: periodical outbreak of chill, high fever and heavy sweating.
(3) Other symptoms and the principle physical signs: splenomegaly, anemia and herpes simplex around the lips.
(4) Fulminate outbreak of malaria; cerebral type, ultrahyperpyrexia type, pulmonary type and gastrointestinal type of malaria; relapse and recrudescence.
(5) Complications: acute intravascular hemolysis (blackwater fever), nephrotic syndrome.
5. Laboratory findings:
(1) Blood routine: leucocytopenia, increment of WBC in subtertian malaria infection; decrement of RBC.
(2) Examining the plasmodium in blood smear and bone marrow smear: the role and diagnostic significance of thick smear and thin smear.
(3) Serologic examination: special antigens and antibodies.
(4) Molecular biology: test the plasmodium nucleic acid of plasmodium.
Diagnostic evidence:
(1) Epidemiologic data;
(2) Manifestations of typical outbreak.
(3) Laboratory findings: Plasmodium found in blood smear and bone marrow smear can help definitive diagnosis.
(4) Diagnostic therapy.
(5) The diseases of differential diagnosis include acute febrile diseases, such as typhoid fever, septicemia and toxic dysentery.
6. Therapy
(1) The common antimalarial drugs: the drugs controlling the clinical outbreak and killing the schizonts; the common cases: the first choice is chloroquine and artesunate. The treatment with the drug-resistant subtertian malaria: the first choice is mefloquine and artesunate.
(2) Prevent the relapse and spread of malaria: primaquine is suitable for the patients without G6PD deficiency.
(3) Drug for prevention: Pyrimethamine.
(4) Treatment with encephalic malaria: symptomatic treatment: control cerebral edema and adrenal cortical hormone; antimalarial treatment: chloroquine or artesunate.
(5) Complications: treatment with blackwater fever: stop pyrimethamine immediately; adrenal cortical hormone; alkalizing the urine. Blood transfusion with low volume for multiple times if necessary.
7. Preventive measures: To kill the plasmodium in human body. Kill out mosquitoes and avoid being bitten; Preventive treatment with drugs; immunologic prevention: no effective vaccine currently.
Teaching methods: To give a lecture with multimedia and powerpoint.
To demonstrate the disease with the typical cases
Reference
3. Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases, 6th ed.
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Websites associated with infectious diseases:
Introduce the knowledge and update research of infectious diseases, related journals, secondary education and experts proseminar.
2. www.chinacdc.net.cn/n272442/n272530/
The update information on the epidemic of infectious diseases and policy. National and foreign information on infectious diseases. Reports of legal infectious diseases.
Pictures related to AIDS. Information about the staging and manifestation of AIDS. Life cycle of HIV (animation). Video and audio related to AIDS. The related law, research, update therapy of AIDS.
4. www.37c.com.cn/topic/058/05801.asp
Knowledge about infectious diseases, laws, therapy and prevention. Therapy and prevention of intestinal infectious diseases, respiratory infectious diseases and other infectious diseases. Medical message and reference.
5. www.chinesehepatology.net.cn
Introduce the information about the update diagnosis and treatment of liver diseases. The clinical experience and scientific research findings about the treatment of liver diseases. Reference searching.
6. Diseases & Conditions: www.emedicine.com
Introduce multiple common infectious diseases.
7. MEDICINE www.emedicine.com/rc/rc/i4/hepatitis.htm
The hot problems about viral hepatitis. The secondary education, clinical practice and abstract of recent published paper. Secondary education of variable infectious diseases (knowledge and advancement).
8. centers for diseases control and prevention （ CDC ） . www.cdc.gov/page.do
Secondary education of infectious diseases. Introduce the advancement, epidemic state, clinical diagnosis and newest treatment of the important infectious diseases, including viral hepatitis, tuberculosis, AIDS, epidemic influenza and avian influenza, hospital infection.
10. www.zhgrb.com
11. www.who.int/en
14. www.cpma.org.cn
15. www.cdcp.org.cn