陈友鹏老师 简介

 MD. ，教授、主任医师，博士生导师 ( 内科学 - 传染病学专业 ) 。

 讲授博士 / 硕士研究生《传染病学诊治新进展》、《急诊医学》，本科
生、全科医学生《传染病学》与《热带病学》。
 社会兼职：中国中西医结合肝病学会青年委员，广东省中西医结
合肝病学会副主任委员，广东省医学会感染病学学会、广东省医
师协会感染性疾病分会、广东省肝脏病学会肝炎组常委。
 为全国疑难及重症肝病攻关协作组第三届委员，广东省艾滋病诊
疗专家组成员，广东省传染病与新发传染病应急防控组专家，柏
林自由大学和洪堡大学 Charité 毒理学研究所高年资研究员，国
际 SCI 期刊《 J DOHaD 》、国内多家核心期刊的审稿专家。
 参编高等院校教材《热带病学》（第 1 、 2 版），已发表论文
100 篇，其中 PNAS 、 Neurosci Behav Rev 、 J Hyper 等
在内的 SCI 论文 27 篇。
Introduction/ general principles
of Infectious Diseases 传染病学总
论

You-Peng Chen
陈友鹏 ,email:
youpeng.chen@163.com
Dept. of Inf. Dis.
the first Affiliated Hospital
of Jinan University
 Questions
 Have you suffered from these
diseases, such as measles,
chickenpox?
Which communicable diseases do you
know appeared in recent ten years?
 Avian flu H7N9 in China, 2017
 Jan. 2017 H7N9: 192 Cases, 79 dead cases ！
 Feb. 6 - Feb. 12 H7N9: 69 Cases, 8 dead
 Feb. 19 ， new variant (drug resistant to
oseltamivir) found in two parients with H7N9
infection.
Since October 1, 2017, there has been only 1
reported human infection.
http://www.stdaily.com/kjrb/kjrbbm/2017-02/27/content_518976.shtml
https://www.cdc.gov/flu/avianflu/h7n9-virus.htm
 Times of SARS
epidemic in 2003

中东呼吸系统综合征冠状病毒 (MERS-CoV)
5
 中国首例输入性寨卡病毒感染
 患者男性， 34 岁，来自江西省赣县，于 2016 年
1 月 28 日出现发热、头痛、眩晕等症状。目前体
温已恢复正常，皮疹消退。
 2 月 5 日回到赣县前曾途经香港和深圳。 2 月 6
日起，他被送入赣县一家医院接受隔离治疗。
 曾到委内瑞拉 (Venezuela) 旅行。

2016-02-11
 Questions ＆ Answers
 1. Which is one extirpated infectious disease by
now?
 Smallpox （ Variola ）
 2. The under diseases are contagious diseases, or
not?
 Gastritis, Duodenitis (stomach & duodenum inflammation)
and gastric and duodenal ulcer.

 Yes--- Helicobacter pylori (HP), tetracycline:

antibiotics
Questions ＆ Answers
 3. Essential hypertension ， heart attack
(myocardial infarction) are contagious diseases, or
not?
 CMV (Cytomegalovirus) infection
 4. Cancers: Cervical carcinoma,
Nasopharyngeal carcinoma, Gastric carcinoma
 HPV [Human papillomavirus]: Cervical carcinoma,
EBV [Epstein-Barr virus, human herpesvirus 4
(HHV-4)]: Nasopharyngeal carcinoma ,
H. pylori: Gastric carcinoma
 Contents
1. Infection and Immunity
2. Pathogenesis of Infectious Diseases
3. Epidemic Process and Influencing Factors

4. Features of Infectious Disease

5. Diagnosis of Infectious Diseases
6. Treatment of Infectious Diseases
7. Prevention of Infectious Diseases
Significance and importance
 3 Basic:

Basic theory,
Basic concept,

Basic method.


to recognize the emerging
infectious diseases
 重点与难点
 感染过程中五种表现的相互转化 five types
of manifestation after infection
 潜伏感染 Latent infection 与隐性感染 Covert
infection 的区别

 基本特征 The basic characteristics of epidemic process

 主动、被动免疫 active/passive immunity
 皮疹出现的顺序与诊断 diagnosis according to
the rashes
 再燃与复发 recrudescence and relapse
 Definition
 1. Non-infectious diseases
 without pathogens
 2. Infectious diseases, with pathogens
Microbes parasites
 1) contagious with transmission
 epidemic meningitis, viral hepatitis
 2) non-contagious without transmission
 appendicitis, cholecystitis
 1. 感染与免疫
Infection and Immunity
 Infection: is the invasion of an organism‘s body tissues by
disease-causing agents, their multiplication, and the
reaction of host tissues to the microorganisms (including
viruses, viroids, prions, bacteria, fungi, and parasites), and
the toxins they produce. 
 Infectious disease, also known as 
transmissible disease or communicable disease.
 It is illness resulting from an infection, and directly
transmitted from one infected individual to another by one
or more of the means, such as droplet contact, airborne
transmission, fecal-oral transmission, sexual contact,
vertical transmission, vector-borne transmission, direct
contact, iatrogenic transmission, and so on.
 Infection-pattern
 Commensalism ( 共生状态 )
 Opportunistic infection ( 机会性感
染)
 Primary infection （首发感染）
 Re-infection （重复感染）
 Co-infection （混合感染 )
 Super-infection ( 重叠感染 )
 Secondary infection （继发感染 )
five Types of Manifestation
after Infection
 Eradication or pathogen clearance
 Covert infection
(Inapparent/subclinical infection)
 Overt infection (apparent/clinical
infection)
 Carrier state
 Latent infection

locec
Spectrum of infection

overt
latent
carrier
eradication
subclinical (covert)
infection
Frequency: Generally, the inapparent infection is
the most, pathogen carrier states follow thirdly and the
apparent infection is the least in the clinic.
(A) Pathogen clearance (eradication)

 The pathogens are cleared by

nonspecific immunity, or neutralized by
specific active or passive immunity of
the body.
 Vibrio cholerae is cleared by gastric
acid.
(B) Covert/inapparent infection
 Inapparent infection has no signs,
symptoms, and biochemical changes. It
can be only detected by immunological
tests.
 most communicable diseases---
(epidemic encephalitis B, poliomyelitis)
 After inapparent infection, most people
can acquire specific active immunity.
 (C) Overt/apparent infection
 the percentage of apparent infection is
the lowest, But a few diseases show
high percentage apparent infection,
such as measles, chickenpox, etc.
 After apparent infection, the people
usually acquires consolidated immunity
(like typhoid) or temporary immunity
(like bacillary dysentery)
 (E) Carrier state
 classified: 1) convalescent carriers,
2) carriers of incubation period,
3) healthy carriers.
 acute (less than 3 months)
 chronic carriers (more than 3 months)
except HBV
 important infectious sources in many
communicable diseases: typhoid fever,
bacillary dysentery, cholera, hepatitis B, etc.
 common characteristic: release pathogens
into the environment without apparent
symptoms.
 (E) Latent Infection

 Pathogen is localized by the body's immunity

and cannot cause apparent infection.
 Pathogen persistently resides in the body and
causes apparent infection only when
immunocompromised, such as herpes zoster,
tuberculosis, malaria, etc.
 Differentiate from carrier state: not to
release pathogen.
The pathogeny for a pathogen

pathogen

1. Invasiveness
2. Virulence: exotoxin,
endotoxin
3. Quantity/Number
4. Variability, variation!
Host/human
 Invasiveness
 Invasiveness refers to the ability that
the pathogens invade the body and
spread within the body.
 Leptospires can invade human body

directly (leptospirosis).
 Vibrio cholerae should adhere to

intestinal mucosa firstly and then

colonize to produce intestinal toxin or
cause infection.
 Virulence
 includes toxins and other toxic factors (like
enzymes, etc). Toxins include exotoxins
and endotoxins.
 Endotoxins can activate mononuclear-
macrophages to produce cytokines to
function. (lipopolysaccharide, LPS)
 Exotoxins (intestinal toxins) can attach the
‘receptor of target organ and play an
important role in the damage to this
organ.
 Immune response to infection
—Host defenses
 includes protective immune
response and hypersensitivity
(allergy)
 Protective immune response, It
includes nonspecific immunity
and specific immunity.
 Nonspecfic immunity
 Natural barriers include outside
barriers (skin, mucous membranous) and
inside barriers (blood-brain barrier,
placental barrier).
 Phagocytosis is functioned by
mononuclear- macrophage system
 Humoral factors include complements,
lysozyme, fibronectin, cytokines, etc.
溶菌酶
 Specific immunity
 Cell-mediated immunity (T cells)

 Humoral immunity (B cells) Sensitized

 Pathogenesis

 Occurrence and Development

 Mechanisms of tissue damages

 Important pathophysiological changes

 Occurrence and development
entrance : mouth, wound

Location: liver, brain, intestine,

respiratory tract, etc

Excluding routes: feces, saliva,

blood.
 avian influenza
bird flu
Caused by H5N1, H7N9
virus, etc.

2005-7-19 30
Pathology of tissue injury

Direct damage: ameba, polio

toxin: endotoxin 、 exotoxin

Immunopathogenesis: AIDS,
hemorrhagic fever with renal syndrome
(HFRS), hepatitis B
 Patho-physiological changes
 Fever pyrogen
 Metabolic change

water electrolytes imbalance

glucose protein endocrine
 Epidemic Process of Infectious
Diseases and the Influencing Factors

 The basic requirements of epidemic

process

 Factors affect epidemic

 Prerequisite for Epidemic
 Sources of infection: patients,
subclinical infected host, pathogen
carriers, infected animals.
 Routes of transmission : by air
tract; by digestive tract; by
immediate or mediate contact ； by
insect; by use of blood or blood
products (transfusion); by body
fluids.
 Susceptible persons.
Features of Infectious Disease
 Basic Characteristics of Infectious
diseases

 Clinical features
 Basic characteristics (four features)
of communicable diseases
 1 、 All communicable diseases
are caused by pathogens.
 2 、 They are communicable,

spreading from one host to

another (between the same
species or different species).
 Basic characteristics
 3 、 They possess epidemiological features
 The prevalence of these diseases calculated by the strength
and breadth can be divided into sporadic, outbreaks,
epidemic and pandemic.
 The incidence of some infectious diseases shows a seasonal
rise to a certain extent and these are known as seasonal
communicable diseases--- seasonality. (Dengue fever)
 Some diseases, such as parasitic diseases, are often limited
to certain areas and are known as endemic communicable
diseases--- endemicity. (Schistosomiasis 血吸虫病 )
 4 、 Specific immunity is acquired after infection
 Clinical features
 Clinical stages of infectious
diseases

 Common signs and symptoms

 Clinical types
Clinical feature-Stage
The typical course of communicable
diseases
 Incubation period:

short: influenza, cholera, shigellosis,

meningococcal meningitis;
medium: typhoid fever, hemorrhagic
fever, leptospirosis, Japanese
encephalitis B.
long: viral hepatitis B, rabies.
 Prodromal period:
 The period of apparent manifestation:
 Convalescent (recovery) period:
 Clinical stages of infectious
diseases
Incubation period
The duration in different disease is also different.
It is an important reference to
quarantine.
Prodromal period
there are nonspecific manifestations in this
period, such as fever, headache, fatigue and
so on.
Period of apparent manifestation
This period has the typical signs and sympotoms.
 Clinical stages of infectious diseases

 Convalescent period
 Relapse The return of the
manifestation of a disease, after ceased
(e.g. typhoid fever, malaria and bacillary
dysentery).
The illness comes back again after its
manifestation is ceased.
 Recrudescence: The temperature
doesn't resolve to normal and start to rise
again.
 Common signs and symptoms
---Fever
 Fever may be caused by
infectious or noninfectious
factors. Most of the acute
infectious diseases have fever.
 Pattern of fever is one of the
important features of infectious
diseases and has differential
signification.
 Common patterns of fever
 Sustained fever: > 39℃ ， little variation
during the day (≤1℃) as in typhoid fever;
 Remittent fever: varying( ≥ 1℃) during
the day, but never normal, as in septicemia;
 Intermittent fever: the temperature
becomes normal at least once each day, as
in malaria, septicemia.
 Relapsing fever: periods of days of fever
separated by a couple of days with normal
temperature, in tuberculosis, dengue fever.
41.0
40.0
39.0
38.0
37.0
36.0
35.0
34.0
8am
8am
8am
8am

8am
8am
8am
8am
8am
8am

8am
Days 6 7 8 9 10 11 12 13 14 15 16
Sustained fever (typhoid fever)
41.0
After treatment
40.0
39.0
38.0
37.0
36.0
35.0

Days 7 8 9 10 11 12 13 14 15

Remittent fever (septicemia)

41
40
39
38
37
36
35
34
33
8am
12pm

8am
12pm

8am
12pm
4pm
8am
12pm
4pm
8am
4pm

4pm

Intermittent fever (septicemia)

 34
35
36
37
38
39
40
41
8am
4pm
12pm
8am
4pm
12pm
8am
4pm
12pm

Relapsing fever
8am
4pm
12pm
8am
4pm
12pm
 Common signs and symptoms
--Rash

 Rashes include exanthem (as in skin)

and enanthem (as in mucous
membrane) ，
 The occurrence time 、 distribution 、
sequence and shape of rashes are
important to the diagnosis and
differential diagnosis for infectious
diseases.
 (1)The occurrence of rashes from onset of fever

 Day 1: as in varicella, chickenpox

 Day 2: as in scarlet fever
 Day 3: as in smallpox
 Day 4: as in measles
 Day 5: as in typhus
 Day 6: as in typhoid fever
 Day 7: as in scrub fever

eruption ： exanthema 、 enanthem: koplik’s spot

notice: time 、 distribution 、 order 、 shape
Dis 风水 猩 天 麻 斑 伤 恙
Day 1 2 3 4 5 6 7
maculo-papular rash
--measles

The occurrence
order (sequence):
behind ears---
face--"trunk-"extremiti
es
Rose spots
Rose spots (papules)
 petechia
 

                                                         
epidemic cerebrospinal
meningitis- petechia
Vesiculo-pustular rash
varicella
(Urticaria)
 petechia
抓痕样出血点
( 肾综合征出血热 )

瘀斑（流脑）

麻疹

多形性皮疹
( 登革
热) 57
Congestive rash
恙虫病的溃疡

eschar
58
 肺炭疽

皮肤炭疽

炭疽杆菌

59
皮肤型利什曼病

60
 Toxemic symptoms
 Endotoxin or other metabolites from the
pathogens can cause tissue damage and
functional disturbances.
 The common symptoms include fever,
fatigue, headache, myalgia.
In some severe cases, toxic myocarditis,
toxic encephalopathy, conscious
disturbance (loss of consciousness),
circulatory failure may be developed.
 Mono-macrophage system
response
  Enlargement of lymph nodes,
Hepatomegaly and
splenomegaly
 commonly seen in viral

hepatitis, EBV infection,

typhoid fever, septicemia,
malaria.
 Clinical types
according to course, severity and
manifestation of the disease.
 classified as acute, subacute, chronic
(course) ；
 mild, medium, severe, fulminant
(severity);
 typical, and atypical types (signs)
Diagnosis: How to reach diagnosis
of a infectious disease
 Diagnosis - making for a
Infectious disease is based on
the following information:
1. Epidemiological information:
2. Clinical profile:
3. Lab. findings:
 Epidemiological data

 ages, professionals, seasons and

resident area susceptible to some
infectious diseases
 The history of vaccinations is
helpful for the immunity of the
patient.
 Clinical manifestations
 The onset of illness has differential
significance and needs special attention.
 Patterns of fever and the accompanying
symptoms, such as diarrhea, headache,
jaundice, should be described for
differentiation.
 Do not pay less attention to the
symptoms of diagnostic importance.
 Laboratory data
-- General lab tests
(1) Blood : esp. WBC
 Neutrophilia: common in purulent bacterial
infection (e.g. epidemic cerebrospinal meningitis,
acute EBV infection, septicemia ).
 Neutropenia: frequent in salmonellae, and virus
infections.
 Eosinophilia: typical in helminth infections (parasites).
 Monocytosis: common in TB.
 Lymphocytosis: viral infections.

(2) Urine: Proteinuria for Hemorrhagic fever with

syndrome (HFRS).
(3) Faeces: Helminth infections and diarrhea.
(4) Biochemical test: It is helpful for the diagnosis of viral
HFRS-membrane-like
substance

  

                                                         

Speciasl Lymphocyte
 Laboratory data
--Pathogen detection

1. Direct examination: some pathogens can be

found from blood smear or bone marrow sample
by microscopy. Parasitic ova can be identified
under microscope from the stool. Cryptococcus
can be directly detected by microscopy with ink
staining.
2. Isolation of pathogen: culturing samples of
blood, urine, faeces, CSF, skin lesions, or other
body fluid.
阿米巴肝脓肿
71
 Laboratory findings
 Detection of specific nucleic acid of
pathogen. The most commonly used
method –Genetic screening: polymerase
chain reaction (PCR). The others are
southern blot for DNA and northern blot
for RNA.
 Immunological test:
Enzyme-linked immunosorbent assay(ELISA)
enzyme immunoassay (EIA), fluorescent
antibody technology(FAT), flow cytometry (FC).
Laboratory data
Findings from medical
diagnostic equipment: endoscopy,
ultrasonography, magnetic
resonance imaging (MRI),
computerized tomography (CT).

Tissue biopsy
Treatment of Infectious
Diseases
Principles of treatment
A). General and supportive
treatment
 General treatment includes
isolation, nursing and psychological
treatment;
 Supportive treatment, includes
proper nutrition and the
maintenance of hydro-electrolytic
equilibrium.
B). Etiological treatment or
specific therapy
 There are antibiotics,
serological and immunological
products, and chemical agents
commonly used.
 Serological and immunological
products include, tetanic
antitoxin 、 interferon,
interferon inducer, etc.
C). Symptomatic treatment

for example, reducing high

temperature, dehydration 、
improvement of circulation etc.
Other therapy

D). Rehabilitating treatment

E). Herbs and acupuncture

Prevention and Control of
Infectious Diseases
 Control of Sources of Infection
 Interruption of Transmission

Routes
 Protection of Susceptible People
Control of Source of Infection
 Surveillance system is an
important measure to detect
communicable diseases early.
 Interruption of Transmission
Routes
 Sterilization, including physical and
chemical sterilization, is an important
measure of interruption of transmission
routes.
Protection of Susceptible People
 Active immunity
to inoculate vaccine, bacterin, and
toxoid.

 Passive immunity
to inoculate antitoxin, γ-globulin and
immunoglobulin
 Natural Environment Destroy

 Have you had these

 Pollution photos in your brain?
 Devastation of forest vegetative cover, earthquake,
 The loss of soil and water
 The safety of foods………… ！
 The infectious disease report card in PR China

category A: pestis, cholera

category B

85
 The infectious disease report card in PR China

category C

86
 It is a battling of human against
infectious diseases!

 There is a long way to prevent

and to control the contagious
diseases!
 Referrences
 Textbook of Tropical medicine( 热带病学 ) (2nd
edition) ， ZHOU Yuan-Ping & Hou Jing-lin.
people’s medical publishing house, Beijing, 2013
 Goldman L and Bennet JC.Cecil Textbook of
Medicine,Part of 　 infectious diseases. 22th
edition ， Part 9. Elsevier
Science （ Singapore ）
 Harrison's Principles of Internal Medicine. 16th
Edition. USA
Thank you