1、狂犬病病毒狂犬病rabes狂犬病病毒狂犬病rabes2nDespite being 100% preventable, one person dies from rabies every ten minutes.n It is estimated that 55,000 people die worldwide from rabies each year. -流行情況-狂犬病病毒狂犬病rabes32007年統(tǒng)計：n中國狂犬病發(fā)病數(shù)全球第2，死亡率近100% n疫情最嚴重的疫情最嚴重的5個省份分別是廣西、貴州、個省份分別是廣西、貴州、四川、湖南和廣東四川、湖南和廣東 -流行情況-狂犬病病毒狂犬病

2、rabes4 生物學性狀n病毒形態(tài)：似子彈狀n是嗜神經(jīng)病毒：可在神經(jīng)細胞中增殖，并在胞漿中形成卵園形的嗜酸性包涵體（內(nèi)基體Negri-body）狂犬病病毒狂犬病rabes5生物學性狀狂犬病病毒狂犬病rabes6nElectron micrograph of rabies virus in brain cells at 64,000 x magnification. The bullets surrounding the smoothe gray circle are rabies.nThe circle itself is the negri body, which can be seen w

3、ith a light microscope. 狂犬病病毒狂犬病rabes7helical nucleocapsid (RNA plus N protein) G glycoprotein SPIKESlipid bilayer membrane M proteinRHABDOVIRUSES狂犬病病毒狂犬病rabes8抵抗力n56。C 30min滅活n100。C 2min全部死亡n常溫 腦組織存活710dn1%甲醛、新潔而滅 滅活狂犬病病毒狂犬病rabes9 易感動物狼狼貓貓狗狗蝙蝠蝙蝠狐貍狐貍狂犬病病毒狂犬病病毒易感動物易感動物狂犬病病毒狂犬病rabes10致病性n傳染源： 狂犬（主） 帶病

4、毒的動物 n感染途徑： 帶病毒的動物 咬傷 狂犬病病毒狂犬病rabes11A rabid dog, with saliva dripping out of the mouth 狂犬病病毒狂犬病rabes12狂犬病病毒狂犬病rabes13nRabies is known to have been transmitted between humans by transplant surgery.狂犬病病毒狂犬病rabes14CasenIn October 2004 a female brown bear killed one human and injured several others nea

5、r the city of Braov in Central Romania. nThe bear was killed by human hunters and diagnosed with rabies. nMore than one hundred humans were vaccinated afterwards.狂犬病病毒狂犬病rabes15致病性n潛伏期：數(shù)天數(shù)年（10d，20年或更長）通常2060dn與多種因素有關(guān)： 咬傷部位 感染年齡 接觸病毒的數(shù)量狂犬病病毒狂犬病rabes16Rabies attacks the Central Nervous SystemnWatch as

6、 the rabies virus from an exposure on the leg spreads up the spinal cord to the brain and throughout the rest of the body.Rabies virus entering the body.狂犬病病毒狂犬病rabes17狂犬病病毒狂犬病rabes18狂犬病常見癥狀n早期癥狀：發(fā)熱、乏力、頭痛、傷口四周及傳入神經(jīng)通路相應(yīng)皮膚麻木、發(fā)癢、疼痛或蟻爬感n中樞神經(jīng)癥狀：煩躁不安、焦慮、郁抑n吞咽或飲水時咽部肌肉痙攣（又名恐水癥）狂犬病病毒狂犬病rabes19恐水癥 渴極畏飲，飲而不能下咽

7、n恐水是本病的特殊癥狀，但不一定每例均有，亦不一定早期出現(xiàn)。n典型表現(xiàn)在飲水、見水、流水聲或談及飲水時，可引起嚴重咽喉肌痙攣。故患者渴極畏飲，飲而不能下咽，常伴有聲嘶和脫水。狂犬病病毒狂犬病rabes20n怕風亦本病常見的癥狀，微風、吹風、穿堂風等可引起咽肌痙攣。n其他如音響、光亮、觸動等，也可引起同樣發(fā)作。狂犬病病毒狂犬病rabes21n驚厥、發(fā)作性全身肌肉痛性抽搐，精神異常、嚎叫、咬人、n麻痹、昏迷、呼吸衰竭而死亡狂犬病病毒狂犬病rabes22A patient with rabies, 1959 狂犬病病毒狂犬病rabes23診斷診斷n臨床特點臨床特點n被動物咬傷被動物咬傷n病理檢查：海

8、馬部神經(jīng)細胞內(nèi)發(fā)現(xiàn)內(nèi)基病理檢查：海馬部神經(jīng)細胞內(nèi)發(fā)現(xiàn)內(nèi)基小體有助診斷小體有助診斷狂犬病病毒狂犬病rabes24防治原則防治原則n控制或消滅傳染源（17.8%是健康帶毒犬咬傷所致）動物接種獸用疫苗狂犬病病毒狂犬病rabes25n被動物咬傷局部處理：主要為清創(chuàng)n1、立即20%肥皂水或0.1%新潔爾滅和清水充分沖洗,至少20分鐘 n2、3%碘酒消毒n3、注意！傷口不包扎與縫合n4、及時注射狂犬病毒疫苗與特異性Ig狂犬病病毒狂犬病rabes26狂犬病病毒狂犬病rabes27小結(jié)狂犬病病毒狂犬病rabes28nChildren are particularly at risk, with almost

9、half of all rabies deaths occurring in children under 15 years. nThe main source of human exposure to rabies, especially in children, is from dogs.n Rabies can be transmitted from dogs not vaccinated against the disease. nUnfortunately, vaccination is neglected in many parts of the world.狂犬病病毒狂犬病rabes29學習學習要求要求1 1、掌握狂犬病病毒內(nèi)基小體