炭疽芽胞杆菌鼠疫耶尔森菌的致病性和防治原则课件

医学微生物学医学微生物学 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 动物源性细菌动物源性细菌 大连医科大学大连医科大学 黄敏黄敏 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 学习重点与难点 1. 掌握动物源性细菌和人畜共患病的概念 ； 2. 掌握布鲁菌、炭疽芽胞杆菌、鼠疫耶尔森 菌的致病性和防治原则； 3. 熟悉的生物学性状，和微生物学检查法； 4. 了解其它动物源性细菌的致病性和防治原 则。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 概述 以动物为传染源，引起人畜共患病的病原 菌称为动物源性细菌。 人类感染的病原菌来自于动物宿主，通过 直接接触动物或其污染物，或经媒介动物 叮咬等途径而传播。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 第一节 布鲁菌属 布鲁斯菌属共有6个生物种、19个生物型。 我国流行的主要是羊布鲁菌病，其次为牛 布鲁菌病。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 形态与染色 G-小球杆菌或短杆菌 培养特性 需氧菌，营养要求较高 抵抗力 较强：在土壤、毛皮、病畜 的脏器和分泌物、肉和乳 制品中可生存数周至数月 一、生物学特性 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 1.致病物质 内毒素 荚膜与侵袭性酶 2.感染途径 人主要通过接触病畜及其分泌物或接 触被污染的畜产品经皮肤、黏膜、呼吸道 、消化道等途径感染。 二、致病性与免疫性 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 人类波浪热 16周的潜伏期 胞内寄生菌 反复形成菌血症及内毒素血症 发热呈波浪型 慢性病变：肝脾肿大 家畜母畜流产 3.所致疾病 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 4.免疫性 以细胞免疫为主 有菌免疫 无菌免疫 型超敏反应（免疫保护及病理损害） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 标本： 血液、骨髓、尿、乳汁及关节渗出液等 分离培养与鉴定： 双相肝浸液培养基 血清学检测： 玻片凝集试验和补体结合试验。布鲁斯菌素皮 肤试验用来诊断慢性布鲁斯菌病或是否感染 过布鲁斯菌。 三、微生物学检查法 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 控制和消灭家畜布鲁菌病 切断传播途径 免疫接种减毒活疫苗 抗生素治疗 急性期和亚急性期患者：利福平与强力霉素联合（ WHO）。 神经系统受累者：四环素合用链霉素。 慢性期患者：除上述病原治疗外，尚需进行脱敏和 对症治疗。 四、防治原则 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 一类G-小杆菌，有13个种和亚种，对人致病主要 有： 鼠疫耶尔森菌鼠疫 小肠结肠炎耶尔森菌小肠结肠炎亚种 小肠 炎、结肠炎、败血症等 假结核耶尔森菌假结核亚种胃肠炎、肠系膜 淋巴肉芽肿 第二节 耶尔森菌属 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 一、鼠疫耶尔森菌 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 1.形态与染色 G-短杆菌、两端浓染 、有荚膜，可呈多形性 2.培养特性 浑浊 沉淀 菌膜（呈“钟乳石”状下沉 ） 2730 3.抵抗力 较弱 24 h 48 h （一）生物学特性 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 4种主要抗原： F1抗原 V/W抗原 外膜抗原 T抗原 4.抗原结构 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. n所致疾病 烈性传染病鼠疫（黑死病） （二）致病性 传播媒介 鼠蚤 传播途径 叮咬伤口、呼吸道 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 临床类型 腺鼠疫 肺鼠疫 败血症鼠疫 死亡率高 n免疫力牢固 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 在专用生物安全实验室检测 标本采集 标本直接涂片镜检 分离培养与鉴定 血清学检测 核酸检测 （三）微生物学检查法 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 预防 灭鼠、灭蚤；尽快隔离患者，阻断人间 鼠疫进一步流行；与患者接触者可口 服磺胺嘧啶；对易感人群进行预防接 种。 （四）防治原则 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 治疗 早期应用抗生素是降低病死率的关键。腺 鼠疫常用链霉素加磺胺类药物；肺鼠疫 和败血症鼠疫常用链霉素或阿米卡星加 四环素治疗。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 革兰阴性球杆菌，无芽胞、无荚膜 。营养要求不高，兼性厌氧。 二、小肠结肠炎耶尔森菌小肠结 肠炎亚种 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 所致疾病： 小肠、结肠炎 结节性红斑与关节炎（自身免疫病） 败血症 本菌引起的肠道感染常呈自限性，不需 要做特殊治疗。 败血症患者的治疗，常采用广谱的头孢 菌素与氨基甙类联用，取得较好的疗效。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 三、假结核耶尔森菌假结核亚种 本菌为革兰阴性，无荚膜、无芽胞。生 化反应与鼠疫耶尔森菌相似。 患病动物易形成多发性粟粒状结核结节 引起的疾病与小肠结肠炎耶尔森菌相似 胃肠炎 肠系膜淋巴结肉芽肿 回肠末端炎 也可发生结节性红斑等自身免疫病 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 需氧，有芽胞，革兰阳性大杆菌 多数为非致病菌（枯草杆菌等） 少数为致病菌 炭疽芽胞杆菌 蜡样芽胞杆菌 第三节 芽胞杆菌属 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 一、炭疽芽胞杆菌 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （一）生物学性状 致病菌中最大的G+粗大 杆菌，两端截平，无鞭 毛； 新鲜标本培养后形成竹 节样排列的长链。有氧 条件和适宜温度下易形 成椭圆形芽胞，位于菌 体中央，宽度小于菌体 ，有毒株可形成荚膜。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 需氧或兼性厌氧，在普通琼脂培养基培养 形成灰白色大而扁平的R型菌落，低倍镜 观察可见卷发状边缘。 抗原有结构抗原（荚膜、菌体和芽胞等） 和炭疽毒素复合物。 芽胞抵抗力很强。对青霉素、氯霉素、红 霉素等多种抗生素敏感。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 人类历史上第一个被发现的病原菌 。 致病物质主要是荚膜和炭疽毒素。 炭疽芽胞杆菌引起食草动物炭疽病 ，人类可经多种途径感染该菌。 （二）致病性与免疫性 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 致病性 人类炭疽病有3种临床类型： 皮肤炭疽：由直接接触患病动物或受染毛 皮所致。 肺炭疽：由吸入芽胞所致。 肠炭疽：由食入未煮熟的病畜肉类、奶或 被芽胞污染的食物所致。 3型均可并发败血症，偶可引起炭疽性脑膜炎 ，死亡率极高。 免疫性 感染炭疽后获得持久性免疫力。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 皮肤炭疽 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 根据病型、病程采取不同标本，直接涂片 、革兰染色或特异性荧光抗体染色镜检。 接种血琼脂平板和碳酸氢钠琼脂平板进行 分离培养。必要时将标本或培养物接种小 鼠或豚鼠。 免疫荧光法检测荚膜抗体，ELISA检查炭 疽毒素，PCR技术检测核酸。 （三）微生物学检查法 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病畜应严格隔离，死畜焚毁或深埋，严禁食 用；易感家畜接种疫苗；患者严密隔离至痊 愈。 易感人群皮上划痕接种炭疽杆菌减毒活疫苗 。 病原治疗首选青霉素G，青霉素过敏者可采 用环丙沙星及红霉素等。 （四）防治原则 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 革兰阳性大杆菌，芽胞多位于菌体中央或 次末端。 在普通琼脂平板上生长良好，菌落较大， 灰白色，表面粗糙似融蜡状，故名。 本菌广泛分布于土壤、水、尘埃、淀粉制 品、乳和乳制品等食品中，可引起食源性 疾病和机会性感染。 二、蜡样芽胞杆菌 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 食物中毒 呕吐型 腹泻型 全眼球炎（外伤后） 心内膜炎、败血症和脑膜炎 所致疾病 本菌对红霉素、氯霉素和庆大霉素敏 感，对青霉素、磺胺类耐药。 治疗 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 第四节 柯克斯体属 柯克斯体属（Coxiella）归属于柯克斯体科，其 下只有一个种，即贝纳柯克斯体，亦称Q热柯克斯 体，是Q热的病原体。 Q热意为疑问热，原指原因不明的发热， Burnet等1937年证明其病原体是一种立克次体，并 命名为贝纳柯克斯体，归类于立克次体目立克次体 科，目前将其暂归类于军团菌目柯克斯体科（据 2004年版伯杰氏细菌分类手册）。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 贝纳柯克斯体形态为短杆状或球状， 革兰染色阴性。 抵抗力较强，耐热，需100至少 10min才能杀死，在干燥蜱粪中可保 持活性一年半左右。 （一）生物学性状 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Q热的传播媒介是蜱，贝纳柯克斯体在蜱体 内可长期存活，并可经卵传代。 蜱叮咬野生啮齿动物和家畜使其感染，多数 无症状，但却是主要的传染源，可通过乳、 尿和粪便长期排泄病原体。 人类主要经消化道或偶尔呼吸道接触而感染 。 致病物质是脂多糖，引起型变态反应是Q 热发病的机制之一。 （二）致病性与免疫性 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Q热分急性与慢性两种。 急性：症状类似流感或原发型非典型肺炎， 发病突然，高热寒战，常有剧烈头痛、肌肉 疼痛和食欲减退，很少出现皮疹。 可并发心包炎和心内膜炎以及精神与神经等 症状。 还可引起肉芽肿性肝炎。 病后可获得一定的免疫力，以细胞免疫为主 ，体液免疫也有一定的作用。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （三）微生物学检查法 该病在早期与流感相似，难以确诊。 一般在发热期间，未用抗生素之前采 取外周血及其血清标本。 目前早期诊断多用间接免疫荧光试验 和ELISA，其敏感性和特异性较高。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （四）防治原则 预防应着重防止家畜的感染，要定期检疫 ，隔离传染源；要严格控制鲜乳和乳制品 的卫生指标。 对流行区的易感人群及家畜可接种相菌 株制成的灭活疫苗或减毒活疫苗。 急性Q热可口服四环素或强力霉素；慢性Q 热多联合应用强力霉素和利福平治疗。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 第五节 巴通体属 巴通体属（Bartonella）归属于巴通体 科，21个种。 汉塞巴通体为猫抓病（cat scratch disease, CSD）的主要病原体。 五日热巴通体为五日热（战壕热）的 主要病原体。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 第六节 弗朗西丝菌属 弗朗西丝菌属（Francisella）是一类呈多形 性的革兰阴性小杆菌，有2个种。 土拉弗朗西丝菌土拉亚种（F.tularesis）为 土拉热的病原体，常引起野生动物的感染 ，特别常见于野兔中，故俗称野兔热杆菌 ，人类常因接触野生动物或病畜引起土拉 热。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 第七节 巴斯德菌属 巴斯德菌属为革兰阴性、卵圆形或杆状细菌 ，对人类致病的主要有多杀巴氏菌。 本菌属可引起低等动物的败血症和鸡霍乱。 人可通过接触染病的动物而感染，所致疾病 有伤口感染、脓肿、肺部感染、脑膜炎、腹 膜炎、关节炎等。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client