临床医学英语幻灯Unit 9 New.ppt

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1、Unit 9,Bird Flu,Questions to consider:,1.What do you know about bird flu?2.How does this disease transmit?3.Talk about bird flu in China.,现代汉语中“禽”字意味着“鸟”，但古汉语中的“禽”字 却是鸟兽的总称,所以“bird flu”一般被翻译成“禽流 感”。这个定义解释很准确(古人还是很聪明),因为鸟 类以外的动物也有可能感染禽流感。自2003年以来全世界共确诊399例人感染H5N1高致病性 禽流感病例，其中252人死亡。H5N1禽流感病毒主要是在禽类中传播

2、。但是专家担心，这种病毒有可能出现变异，导致人与人之间相互传染。,About bird flu,流感的病毒抗原結構分H和N兩大類:H代表 Hemagglutinin(血細胞凝集素),有如病毒的 鑰匙，用來打開及入侵人類或牲畜的細胞；N代表 Neuraminidase(神經氨酸酶),是幫助病毒感染 其他細菌的酵素。,New death from bird flu in China,A Chinese woman has died from bird flu in the eastern Shandong province,state media has said.It says Ms Zhang

3、,aged 27,died at the weekend after becoming infected with the H5N1 strain of avian influenza.It is the second reported death from bird flu in China this year.Two weeks ago,a 19-year-old woman died in Beijing after handling ducks.The latest death was announced the day after the infection of a two-yea

4、r old with bird flu in Hunan was reported.,The three new cases are the first to be reported in China in almost a year.The toddler is now in hospital in her home province of Shanxi and all those who had been in contact with her are being watched.The toll from bird flu in China is now reported by stat

5、e media as 22 since 2003.Chinas ministry of agriculture said on Sunday that no bird flu epidemics were detected in Shanxi and Hunan provinces after the two-year-olds infection was confirmed.,Grim threat The ministry said China now faces a grim situation in bird flu prevention,threatened by frequent

6、outbreaks in neighbouring countries,the Chinese state news agency Xinhua reported.Other threats came from brisk poultry trade ahead of the Spring Festival and difficulties in taking prevention measures at loosely managed household farms,it said.Bird flu often resurges in the winter months in China,b

7、ut not every case is fatal.,China has the worlds biggest poultry population and is seen as critical in the fight to contain H5N1,which resurfaced in Asia in 2003,killing at least 247 people.H5N1 does not transmit easily to humans but experts fear it could mutate and cause a worldwide pandemic.Date:2

8、009-02-08,Introduction,Bird flu-viral respiratory disease,mainly of birds including poultry and waterbirds but also transmissible to humans.Symptoms in humans include fever,sore throat,cough,headache,and muscle aches.Severe infections can result in life-threatening complications such as pneumonia an

9、d acute respiratory illness.The first known human cases occurred in Hong Kong in 1997,resulting in six deaths.,Deadly outbreaks among poultry in several countries in eastern and central Asia between 2003 and mid-2005 were accompanied by more than 100 human cases,about half of them fatal.The causativ

10、e agents are virus subtypes related to the human influenza type A viruses,the most virulent and contagious being the H5N1 subtype.A specific protective vaccine for this virus remains to be developed.Studies suggest that some antiviral drugs that work against human influenza may be effective in treat

11、ing bird flu in humans.,Background:With the flu spreading around the world,the virus has turned up in birds in Asia,Europe and Africa.So far,bird flu has mostly been passed from birds either to other birds or,in isolated cases,to humans.In June 2006,WHO reported the first case of human transference

12、of the disease,when an Indonesian man died after catching the flu from his 10-year-old son.If the flu mutates into a strain that can pass more readily from human to human,people will have no immunity and the flu will probably pass rapidly from person to person,creating a pandemic.,Flu vaccines can o

13、nly be made to protect against a particular virus,and,since the virus had yet to be passed from human to human,no vaccine has been developed.In Asia,many people live with ducks and chickens in their homes and in their yards.Health and veterinary officials worldwide announced that a key way to stop t

14、he spread of the disease is to improve farming practices,segregating poultry from humans,and culling birds that have been infected with the deadly virus.,H5N1,The highly pathogenic Influenza A virus subtype H5N1 virus is an emerging avian influenza virus that has been causing global concern as a pot

15、ential pandemic threat.It is often referred to simply as bird flu or avian influenza even though it is only one subtype of avian influenza causing virus.,H5N1 has killed millions of poultry in a growing number of countries throughout Asia,Europe and Africa.Health experts are concerned that the co-ex

16、istence of human flu viruses and avian flu viruses(especially H5N1)will provide an opportunity for genetic material to be exchanged between species-specific viruses,possibly creating a new virulent influenza strain that is easily transmissible and lethal to humans.,Since the first H5N1 outbreak occu

17、rred in 1997,there has been an increasing number of H5N1 bird-to-human transmissions leading to clinically severe and fatal human infections.However,because there is a significant species barrier that exists between birds and humans,the virus does not easily cross over to humans,though some cases of

18、 infection are being researched to discern whether human to human transmission is occurring.,More research is necessary to understand thepathogenesis and epidemiology of the H5N1 virus in humans.Exposure routes and other disease transmission characteristics such as genetic and immunological factors,

19、that may increase the likelihood of infection,are not clearly understood.,Prevention:Since the avian flu virus is destroyed by heat,be sure to eat only well-cooked poultry and eggs.Make sure that utensils and kitchen surfaces where eggs and raw poultry are handled are kept clean.Separate raw poultry

20、 from cooked foods.In the meantime,good hygiene remains the best prevention:keep hands well-washed,and avoid contact with people who have been infected with the virus.,Understanding the Text,Para.11.avian-of or relating to birds 鸟的 avian influenza A(H5N1)virus-甲型禽流感（H5N1）病毒2.highly pathogenic-高致病性3.

21、species barrier-物种屏障4.fatality-deathe.g.事故使数人死亡。,The accident caused several fatalities.,5.epidemic/endemic/pandemic6.pose a threat/challenge(to)在亚洲,一场史无前例的高致病性动物流行病 甲型禽流感（H5N1）病毒跨越物种屏障,造成 许多人死亡,并构成越来越严峻的大流行威胁。,Para.21.human influenza A(H5N1)-人甲型流感 2.to parallel large outbreaks of-大规模平行暴发 3.avian ep

22、idemics-禽流感流行 4.frequencies-发生率 5.seroprevalence studies-血清流行率的研究,Para.31.droplet nuclei-飞沫核 2.conjunctival mucosa-结膜的黏膜 3.to date-up to now,at present4.consistent with-5.nonsustained-Last sentence:对于人甲型流感（H5N1）感染，目前证据符合 禽人传播，可能存在环境人传播，还有少 数未得到证据支持的人人传播。,Para.41.exposure(to)-接触 2.onset of illness-发病

23、 3.ill poultry-病禽 4.butcher-屠宰 5.cull-to reduce the size of a group of animals by killing its weakest members 挑出杀掉;剔除6.pluck-to pull the feathers out of a chicken,etc.in order to prepare it for cooking 拔去(鸡等的)毛(以备烹调),7.implicate-involve 牵连,与有关系;影响8.initiate-start 加工处理病禽；触摸斗鸡；玩弄家禽，尤其是无症状 但已感染的鸭；进食鸭血或

24、可能未煮熟的家禽都有危 险因素。在泰国动物园已经观察到，由于给老虎和豹 喂食感染的生鸡，发生了对猫科动物的传播，有人在 实验条件下观察到对家猫的传播。已有人发现在实验 室条件下猫科动物之间的传播。一些感染可能始于咽 部或胃肠道接种病毒。,Para.51.household clusters-2.intimate contact-3.serologic surveys-血清调查 4.RT-PCR assay-逆转录酶聚合酶链反应测定 5.mild cases-轻症病例 6.small-particle aerosol-,aerosolrsl n.-烟,雾;悬浮(大气)尘粒,带有悬浮粒的气体;烟雾

25、剂;湿润剂;气溶胶;按钮式喷雾器;气雾剂(用于空气消毒或吸入疗法)e.g.1)small-particle aerosol generator(SPAG）细小颗粒气雾产生器 2)aerosol administration during mechanical ventilation 机械通气时气雾的给予 3)Investigation of mycoplasma pneumonia in children treated by aerosol inhalation of Keerning 咳儿宁雾化吸入治疗小儿支原体肺炎的临床观察,Para.6oral ingestion of译:游泳时喝了被

26、污染的水，在接触时发生鼻内或结膜 的直接病毒接种都是其它潜在的传播模式，这些情 况同手被具有传染性的污染物所污染随后发生自我 病毒接种一样。,Para.71.clinical spectrum of译:人甲型流感（H5N1）的临床表现基于对住院患者 的描述。2.subclinical infection-亚临床感染 3.atypical presentation-非典型表现,Para.81.incubation period-2.interval-3.range-4.case-to-case intervals in household clusters,Para.91.initial sym

27、ptoms-2.early in the course of illness-3.watery diarrhea-terms related to diarrhea:Frequent Bowel Movements Loose Bowel Movements Loose Stool Watery Stool 4.precede(by)-to come or go before 在之前;先于5.present(with),Para.101.at presentation-在就诊时 2.series-系列观察 3.a median of-中位时间5天中（范围1-16天）4.respiratory

28、distress-呼吸窘迫 5.inspiratory crackles-吸气湿罗音 6.variable/bloody-痰量不等，有时带血。7.diffuse,multifocal,or patchy infiltrates-弥漫性、多灶性或斑片状浸润 8.interstitial infiltrates-间质浸润,9.segmental or lobular consolidation-节段性或叶性实变 10.air bronchograms-空气支气管征 11.pleural effusions-胸腔积液 12.primary viral pneumonia-原发性病毒性肺炎 13.ba

29、cterial suprainfection-细菌叠加感染,bronchogram：支气管造影片 air bronchogram：支气管含气显影;支气管气像,空气支气管征肺实质的急性炎症主要表现为渗出，肺泡内的气体被 渗出的液体、蛋白及细胞所替代，而形成实变，大片 状影中有时可见其内充气的支气管造影称为空气支气管征或支气管气象（air bronchogram)，多见于大叶 性肺炎。e.g.Air-bronchogram and pleural effusion were seen in 2 of the cases.空气支气管征合并胸腔积液2例。,Para.111.ground-glass i

30、nfiltrates-毛玻璃样渗出2.ARDS-急性呼吸窘迫综合征 3.cardiac compromise/dilatation-4.supraventricular tachyarrhythmias-室上性心动过速性心律失常 5.ventilator-associated pneumonia-呼吸机相关肺炎 6.Reyes syndrome-7.documented-(没有菌血症证据的脓毒症综合征),Reye syndrome,an extremely rare but serious illness that can affect the brain and liver,occurs m

31、ost commonly in kids recovering from a viral infection.Named after Australian pathologist R.Douglas Reye,who first reported it as a distinct syndrome in 1963,Reye syndrome is still not well understood.Studies have linked the use of aspirin or aspirin-containing medications during viral disease to de

32、velopment of Reye syndrome.Cases have dropped dramatically since the finding of a link between the illness and aspirin use in children.,Para.121.fatality rate-死亡率 overall rate-总死亡率 case fatality rate-病死率 2.progressive/progression/progress-,Para.131.mild-to-moderate-轻中度 2.slightly or moderately eleva

33、ted levels-水平轻度或中度升高 3.marked/pronounced-4.at the time of admission/discharge-,Para.141.viral isolation/H5-specific RNA-分别用病毒分离和检测H5特异RNA或两者同时 使用，可在患者死亡前证实甲型流感（H5N1）诊断。2.detection-检出(率);3.throat-swab samples-咽拭子标本 4.viral loads in pharyngeal swabs-咽拭子病毒负荷量 5.nasopharyngeal samples-鼻咽标本 mercial rapid

34、 antigen tests-商品化的快速抗原检测方法 7.culture-positive-培养物阳性,Para.151.empirical-routine2.antiviral agents-抗病毒药物 3.assess-(严格)评估 4.institution-实施 5.initiation-使用6.oseltamivir-奥司他韦(达非)在病程的后期实施这些干预措施并没使总死亡率明显 下降。在患者使用奥司他韦后2天或3天内培养出病毒 便消失了。但在死亡的患者中，尽管早期服用过奥司 他韦治疗，临床病情仍有发展，咽部病毒负荷并无下 降。,【通用名称】磷酸奥司他韦胶囊【英文名称】Oselta

35、mivir Capsules【商品名称】达菲 Tamiflu,达菲分子式示意图,目前市场上销售的达菲为瑞士罗氏制药独家生产的抗 流感药物，其通用名称为磷酸奥司他韦(Oseltamivirphosphate）。奥司他韦（Oseltamivir）于1999年在瑞士上市，2001 年 10月在我国上市。达菲是一种非常有效的流感治疗用 药，并且可以大大减少并发症（主要是气管与支气管炎、肺炎、咽炎等）的发生和抗生素的使用，因而是目前治 疗流感的最常用药物之一，也是公认的抗禽流感、甲型 H1N1病毒最有效的药物之 一。,副作用调查日本卫生部门对抗流感药物“达菲”可能产生的副作用展开调查。2007年，2月2

36、6日午夜，一名14岁男孩在服用“达菲”后从仙台市一座公寓楼的11层跳下身亡，这是日本在过去17个月里发生的第18起与这种畅销药物有关的青少年死亡事件。在这起最新死亡案件中，这名男孩的医生让其连续服用“达菲”5天。26日，这名男孩服用了2片“达菲”。当晚，在其醒来后，他告诉其母亲他要去洗手间，然后，他却拉开正门走了出去。他母亲感觉有些不对劲，并跟了过去。当她看到他正在爬上一个1.3米高的栏杆时，她大声呼叫。警方说，这名男孩没有做出任何回应就一头跳了下去。警方表示，他们不认为这名男孩是想自杀。,两周前，一名14岁少女在服用达菲之后，从爱知县蒲郡市一座公寓楼跳下死亡。目前，日本厚生劳动省已要求进口“

37、达菲”的厂家收集服用过这种抗流感药病人的健康情况。在这起事件发生后，日本厚生劳动大臣柳泽伯夫呼吁大众保持冷静。他说：“我们需要确凿的证据。”厚生劳动省称，医药公司报告说，截止到去年11月，已有54名服用“达菲”的人在日本死亡。美国食品和药品管理局（FDA）去年11月曾警告说，“达菲”可能会在患者，特别是儿童中引起精神错乱和幻觉等严重的副作用，甚至造成死亡。该局提议对美国境内的“达菲”的说明书进行修改，并建议医生和父母们仔细阅读说明书，对服药后的患者也要进行密切观察。,Phrases in the Text,1.Highly pathogenic2.Species barrier3.Avian

38、influenza A(H5N1)4.Seroprevalence studies5.Droplet nuclei6.Upper respiratory tract7.Conjunctival mucosa8.Routes of transmission9.Onset of illness,10.Pharyngeal inoculation of virus11.Household clusters12.Intimate contacts13.Exposed health care workers14.Serologic studies/surveys15.Intensified survei

39、llance16.RT-PCR assay17.Mild cases18.Epidemiologic/virologic studies,19.Appropriate isolation measures20.Oral ingestion21.Clinical feature/course22.Subclinical infections23.Atypical presentation24.Incubation period25.Initial symptoms26.Pleuritic pain27.Early in the course of illness,28.Watery diarrh

40、ea29.Respiratory manifestations30.Inspiratory crackles31.Sputum production32.patchy/interstitial infiltrates33.Segmental/lobular/multifocal consolidation34.Air bronchogram35.Pleural effusions36.Primary viral pneumonia,37.Bacterial suprainfection38.Acute respiratory distress syndrome(ARDS)39.Renal dy

41、sfunction40.Cardiac compromise/dilatation41.Supraventricular tachyarrhythmias42.ventilator-associated pneumonia43.Pulmonary hemorrhage44.Reyes syndrome45.Fatality rate/case fatality rate,46.Progressive respiratory failure47.Mild-to-moderate thrombocytopenia48.Lymphocyte counts49.Viral isolation50.Throat-swab samples51.Viral loads in pharyngeal swabs52.Rapid antigen testing53.Patients with culture-positive influenza A(H5N1)54.Early initiation of antiviral agents,