推荐回答(2个)
概述
水痘由水痘-带状疱疹病毒所引起的急性呼吸道传染病。水痘是原发性感染,多见于儿童,临床上以轻微和全身症状和皮肤、粘膜分批出现迅速发展的斑疹、丘疹、疱疹与结痂为特征。
病因
(一)传染源:水痘患者为主要传染源,自水痘出疹前1~2天至皮疹干燥结痂时,均有传染性。
(二)传播途径:主要通过飞沫和直接接触传播。在近距离、短时间内也可通过健康人间接传播。
(三)易感人群:普遍易感。但学龄前儿童发病最多。6个月以内的婴儿由于获得母体抗体,发病较少,妊娠期间患水痘可感染胎儿。病后获得持久免疫,但可发生带状疱疹。
(四)流行特征:全年均可发生,冬春季多见。本病传染性很强,易感者接触患者后约90%发病,故幼儿园、小学等幼儿集体机构易引起流行。
症状
潜伏期14~16日:
(一)前驱期:婴幼儿常无前驱症状。年长儿或成人可有发热头痛、全身不适、纳差及上呼吸道症状,1~2日后才出疹。偶可出现前驱疹。
(二)出疹期:发热同时或1~2天后出疹,皮疹有以下特点:
1.先见于躯干、头部,后延及全身。皮疹发展迅速,开始为红斑疹,数小时内变为丘疹,再形成疱疹,疱疹时感皮肤搔痒,然后干结成痂,此过程有时只需6~8小时,如无感染,1~2周后痂皮脱落,一般不留瘢痕。
2.皮疹常呈椭园形,3~5mm,周围有红晕,疱疹浅表易破。疱液初为透明,后混浊,继发感染可呈脓性,结痂时间延长并可留有瘢痕。
3.皮疹呈向心性分布,躯干最多,其次为头面部及四肢近端。数目由数个至数千个不等。
4.皮疹分批出现,同一部位可见斑疹、丘疹、疱疹和结痂同时存在。
5.口腔、外阴、眼结合膜等处粘膜可发生浅表疱疹,易破溃形成浅表性溃疡,有疼痛。
检查
1.血象白细胞总数正常或稍增高。
2.疱疹刮片或组织活检,刮取新鲜疱疹基底物用瑞氏或姬姆萨染色检查多核巨细胞,用酸性染色检查核内包涵体。
3.病毒分离检查。
4.血清抗体检测 可用补体结合试验等方法测定。
治疗
(一)一般处理与对症治。
呼吸道隔离,卧床休息,加强护理,防止庖疹破溃感染。皮疹已破溃可涂以龙胆紫或新霉素软膏。继发感染者应及早选用敏感的抗生素。瘙痒者可给予炉甘石洗剂及抗组织胺药物。并发肺炎、脑炎按肺炎和脑炎治疗 。激素一般禁用,当合并有严重并发症时,在应用有效抗生素的前提下,酌情使用。
(二)抗病毒疗法。
干扰素,10~20万μ/日,连用3~5天 ;其他如阿糖腺苷、无环鸟苷等也可选用。
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