医学保健肠道感染病毒课件

Human Human enterovirusenterovirus Viruses of causing acute gastroenteritisViruses of causing acute gastroenteritis PoliovirusPoliovirus CoxsackievirusCoxsackievirus group A : types 122, 24 group B : types 16 Enteric Enteric cytopathogeniccytopathogenic human human orphan(ECHO) virus orphan(ECHO) virus New New enterovirusesenteroviruses (types 13) (31 types) (types 6871) of of enterovirusenterovirus Shape and structureShape and structure d=2430 nm, spherical and naked virus with icosahedral nucleocapsid polyproteinpolyprotein VP1VP4 and functional proteinVP1VP4 and functional protein 衣壳蛋白衣壳蛋白(VP1(VP1与受体结合与受体结合) ) genome:+ssRNA 1.Biological properties1.Biological properties Cultivation RresistanceRresistance(stronger) (pH39(pH39稳定稳定, ,污水和粪便中可存活数月污水和粪便中可存活数月) ) Type-specific antigenType-specific antigen D(density)/N(native) antigen C (coreless) antigen primary cell culture-CPE animal inoculation (A1,A19,A22) 2.2.Pathogenicity of Pathogenicity of enterovirusesenteroviruses Replicate in the intestinal tract and Replicate in the intestinal tract and spread through bloodstream to target spread through bloodstream to target organsorgans Via fecal-oral route cause a variety Via fecal-oral route cause a variety of diseases or syndromes of diseases or syndromes (夏秋季为主要流行季节) 不同肠道病毒可引起相同的临床症状,同一种 病毒可引起几种不同的临床疾病 P275276表 (通常有二次病毒血症) -from subclinical infection to severe infection of CNS source of infectionsource of infection (patients and carrier) cause poliomyelitis by fecal-oral routecause poliomyelitis by fecal-oral route clinical findings of poliomyelitisclinical findings of poliomyelitis Poliovirus (neurotropic virus) *subclinical infection(90%) *abortive infection (5%) *nonparalytic poliomyelitis/aseptic meningitis(1-2%) *paralytic poliomyelitis(0.1%-2%) nonparalyticnonparalytic : paralytic=1001000 : 1 : paralytic=1001000 : 1 -pathogen of poliomyelitis-pathogen of poliomyelitis(脊髓灰质炎或小儿麻痹症) CoxsackievirusCoxsackievirus and ECHO virus and ECHO virus EnterovirusEnterovirus 71 71 -cause a variety of diseases or -cause a variety of diseases or syndromessyndromes (such as aseptic meningitis and encephalitis and so.on) (P275276P275276表表) ) initial site of infection and route of transmission E70,CA24 and Ad3,7AHC (急性出血性结膜炎) -The main cause of acute The main cause of acute hemorrhagic conjunctivitis (AHC)hemorrhagic conjunctivitis (AHC) EnterovirusEnterovirus 71 71 - lifelong type-specific immunity ( neutralizing antibody ) -causecause viral CNS diseaseviral CNS disease (such as aseptic meningitis and encephalitis and so.on) and HFMDHFMD(hand-foot-and-mouth disease,手足口病) 3.3.ImmunityImmunity of of enterovirusesenteroviruses (neurotropic virus) 4.4.Laboratory diagnosis Laboratory diagnosis of of enterovirusesenteroviruses Isolation and identification of virus Isolation and identification of virus Detection of viral antibody and RNADetection of viral antibody and RNA 5.5. Specific prevention of Specific prevention of poliovirus Artificial active immunity Artificial passive immunity IPV ( Salk vaccine) IPV ( Salk vaccine) OPV(SabinOPV(Sabin vaccine ) vaccine ) 均均为为三价混合疫苗；但三价混合疫苗；但 OPVOPV与疫苗相关麻痹型脊髓与疫苗相关麻痹型脊髓 灰质炎灰质炎(VAPP)(VAPP)发生有关发生有关 (CPE)(CPE) -Viruses of causing -Viruses of causing acute gastroenteritis acute gastroenteritis Rotavirus (RV)Rotavirus (RV) OOther acute gastroenteritis virus ther acute gastroenteritis virus 1. 1.Shape of Shape of virionvirion -d=60-80nm, spheric and naked virus with double-shelled capsid 2.Genome 2.Genome a appearance of a “wheel”ppearance of a “wheel” ( (轮状病毒轮状病毒) ) consists of 11 segments of ds-RNA code for 6 structural proteins(VP1-4,6,7) and 5 non-structural proteins (NSP1NSP5) 3.Pathogenicity3.Pathogenicity Source of infection Source of infection Route of transmission Route of transmission The main The main viral viral cause cause of of acute gastroenteritis acute gastroenteritis group A: main pathogen of acute gastroenteritis in infants group B cause epidemic diarrhea in adult group C: cause human or animal sporadic diarrhea ( (or ADRV)or ADRV) (6(6个月个月22岁岁) ) 4. 4. Diagnosis of infectionDiagnosis of infection Detection of viral particle Detection of viral particle and viral antigen and viral antigen (EM,ELISA) PAGE & RT-PCRPAGE & RT-PCR (聚丙烯酰胺凝胶电泳) Including:Including: Enteric adenovirusEnteric adenovirus CalicivirusCalicivirus C Cause viral ause viral gastroenteritis by fecal- gastroenteritis by fecal- oral route oral route * * SRSV SRSV (small round structured virus)(small round structured virus) * * “ “classic” classic” caliciviruscalicivirus (Classified as (Classified as HuCVHuCV) ) 其原型病毒为Norwalk 病毒 无菌性胃肠炎暴发流行最重要病原体 流行季节: 冬季 可累及任何年龄组 5 5岁以下小儿腹泻岁以下小儿腹泻 主要引起5岁以下小儿腹泻(5%20%为隐性感染) 冬季流行 2.Other acute gastroenteritis virus2.Other acute gastroenteritis virus EAd-40, 41 and 42EAd-40, 41 and 42型是引起型是引起婴 儿病毒性腹泻的第二位病原体 AstrovirusAstrovirus 急性肾小球肾炎的的病理改变是肾脏体积可较正常增大，病变主要累及肾小球。病理类型为毛细血管内增生性肾小球肾炎。光镜下通常为弥漫性肾小球病变，以内皮细胞及系膜细胞增生为主要表现，急性期可伴有中性粒细胞和单核细胞浸润。病变严重时，增生和浸润的细胞可压迫毛细血管袢使毛细血管腔变窄、甚至闭塞，并损害肾小球滤过膜，可出现血尿、蛋白尿及管型尿等；并使肾小球滤过率下降，因而对水和各种溶质（包括含氮代谢产物、无机盐）的排泄减少，发生水钠潴留，继而引起细胞外液容量增加，因此临床上有水肿、尿少、全身循环充血状态如呼吸困难、肝大、静脉压增高等。肾小管病变多不明显，但肾间质可有水肿及灶状炎性细胞浸润。 急性肾小球肾炎治疗：本病治疗以休息及对症为主，少数急性肾功能衰竭病例应予透析，待其自然恢复。不宜用激素及细胞毒素药物。 一、一般治疗 肉眼血尿消失、水肿消退及血压恢复正常前应卧床休息。予低盐（3g/d）饮食，尤其有水肿及高血压时。肾功能正常者蛋白质入量应保持正常（每日每公斤体重1g），但氮质血症时应限制蛋白质摄入，并予高质量蛋白（富含必需氨基酸的动物蛋白）。仅明显少尿的急性肾功能衰竭病例才限制液体入量。 二、治疗感染灶 首选青霉素（过敏者更换为对革兰氏阳性菌高度敏感的大环内酯类、头孢第一代抗生素）800万单位静脉滴注，1014天，但其必需性现有争议。反复发作的慢性扁桃体炎，待肾炎病情稳定后（尿蛋白小于（+），尿沉渣红细胞少于10个/高倍视野）可作扁桃体摘除，术前、后两周需注射青霉素。 三、对症治疗 利尿、消肿、降血压。常用噻嗪类利尿剂（如双氢氯噻嗪25mg,每日23次），必要时才予利尿剂如呋塞米2060mg/d, 注射或分次口服。利尿后高血压值仍不满意时，可加用钙通道阻滞剂如硝苯啶2040mg/d, 分次口服或血管扩张药如肼酞嗪25mg,每日3次。但保钾利尿药（如氨苯蝶啶及安体舒通）及血管紧张素转化酶抑制剂，少尿时应慎用，以防诱发高血钾。 慢性肾炎 图书 四、中医