微生物医学-第8章 化脓性球菌

1,医学微生物学,刘志军潍坊医学院微生物学教研室Z,2,学习目的与要求,掌握化脓性球菌的种类 掌握致病性葡萄球菌、链球菌、肺炎链 球菌、脑膜炎奈瑟菌、淋病瑟菌的主要生 物学特性、致病物质、所致疾病、重要的微生物学检查方法、 防治原则。,临床标本分离及化脓 性球菌的初步鉴定、,3,化脓性感染经常发生，谁是罪魁祸首 ？,Introduction,化脓性细菌简介,4,球菌Pyogenic Coccus,杆菌Pyogenic Bacillus,Introduction,5,According to gram stain Results革兰阴性球菌 G脑膜炎奈瑟菌、淋病奈瑟菌等Gram-negative cocci G Meningococcus, Gonococcus etc.,化脓性球菌分类 (革兰染色) 革兰阳性球菌 G葡萄球菌、链球菌、肺炎链球菌等 Gram-positive cocci G Staphylococcus, Streptococcus, Pneumococcus etc.,病原性球菌主要引起化脓性炎症，又称为化脓性球菌。These bacteria are significant causes of purulent (化脓性的) infections they are often referred to collectively as the pyogenic cocci.,6,种类：大肠埃希菌、变形杆菌属、假单胞菌属、产气芽胞梭菌、无芽胞厌氧菌,化脓性杆菌：引起人类化脓性炎症的一类杆菌。大多为革兰阴性菌。,7,自然界分布广泛，是最常见的化脓性球菌。The genus Staphylococcus is a common inhabitant of the skin and mucous (粘膜)membranes, it distributes widely and accounts for a considerable proportionof human infections,葡萄球菌属Staphylococcus,Section 1,StaphylococcusOverview,it is an important source of hospital infection.,8,9,Biological Properties 生物学性状 Pathogenesis 致病性 Immunity 免疫性 Laboratory diagnosis 微生物学检查方法 Principles of prevention and treatment 防治原则 Case discussion 病例讨论,Section 1,StaphylococcusOverview,10,一、生物学性状Part Biological Properties,11,注意临床标本实验室标本不一致性！,12,一、生物学性状Part Biological Properties,13,Division in several directions produces irregular clusters.,葡萄球菌,14,Scanning electron micrograph ofStaphylococcus aureus (金葡菌)(7,500),15,(7,500),16,Staphylococcus aureus (金葡菌) 革兰染色(1000),17,脓汁标本 (1000),18,一、生物学性状Part Biological Properties,19,普通平板：金葡菌菌落Golden colony of S. aureus on common agar,血平板：金葡菌溶血现象Hemolysis of S. aureus on blood agar,20,QuestionHow to describe a colony(菌落) ?,金葡菌菌落,21,一、生物学性状Part Biological Properties,22,一、生物学性状Part Biological Properties,23,一、生物学性状Part Biological Properties,24,一、生物学性状Part Biological Properties,25,Ag Structure,Capsule,多糖抗原（磷壁酸）,SPA,Cytoplasm,26,葡萄球菌A蛋白(Staphylococcal protein A, SPA）,Ag Structure,27,SPA协同凝集试验主要用于临床病原体快速检测,将针对可溶性抗原的IgG抗体与葡萄球菌(SPA)结合，然后加入待测标本，若标本中含有相应的可溶性抗原，则抗原抗体结合，使葡萄球菌聚集，出现凝集现象。,金葡菌,形成大的凝集颗粒,28,Relationship to disease (only 3 important)金黄色葡萄球菌 S. aureus: causes a number of diseases表皮葡萄球菌 S. epidermidis: present in normal flora腐生葡萄球菌 S. saprophyticus: No infections occur,一、生物学性状Part Biological Properties,29,三种葡萄球菌的主要性状,30,一、生物学性状Part Biological Properties,6. 抵抗力葡萄球菌对外界因素的抵抗力强于其他无芽胞菌。 三耐 一敏感 一多,ResistanceThis species is considered the most resistant of all non-spore-forming pathogens.,三耐 耐干燥 Drying resistance 耐热 Withstand high temperatures 耐盐 Withstand high salt 碱性染料敏感 Sensitive to crystal violet 耐药菌株迅速增多 Resist antibiotics,31,金黄色葡萄球菌耐药菌之多令人瞠目结舌，普通的抗生素几乎不发挥作用，金葡菌特效药、首选药万古霉素在美国也发现了耐药菌株。耐甲氧西林的金黄色 葡萄球菌（MRSA）已成为医院内感染最常见的菌。也许抗生素一针见效的年代已经一去不复返了，我们又回到了抗生素的发明时代，对感染束手无策。,耐药性变异,令人心烦的问题,32,The genus(属) Staphylococcus contains 32 species. Most of these are human commensals(共生生物), but S. aureus, S. epidermidis can be pathogenic.,All species in the genus Staphylococcus are gram-positive facultative anaerobes(兼性菌) that tolerate extremes of temperature, osmotic pressure(渗透压), and drying. All are catalase-positive(触酶阳性) .,广泛分布于自然界及人和动物的皮肤及与外界相通的腔道中。一般鼻咽部带菌率为20%50%，医务人员的带菌率可高达70%以上，是医院内交叉感染的重要传染源。,Checkpoint,33,二、致病性Part Pathogenesis,(一)、致病物质,34,二、致病性Part Pathogenesis,酶 凝固酶、纤维蛋白溶酶、耐热核酸酶、透明质酸酶、脂酶、触酶,毒素 葡萄球菌溶素、杀白细胞素、毒性休克综合征毒素-1、肠毒素、表皮剥脱毒素等,其他 结构蛋白(SPA)、黏附素、荚膜、胞壁肽聚糖等,35, 定义致病性葡萄球菌产生的能使含有枸橼酸钠或肝素等抗凝剂的人或兔血浆发生凝固的酶类物质。Enzymes that cause clotting of blood plasma containing anticoagulant., 致病机理：抵抗吞噬细胞的吞噬保护细菌不受血清中杀菌物质的破坏使感染局限化和形成血栓Protect against phagocytosis， make the infection localized.,1. 凝固酶 Coagulase, 意义：鉴别葡萄球菌有无致病性的 重要指标之一。Identification Positive Pathogen,36,凝血酶样物质, 种 类,协同因子,纤维蛋白原,纤维蛋白,血浆凝固(试管法),游 离 凝固酶,结合凝固酶,纤维蛋白原受体,受体配体结合,血浆凝固(玻片法),细菌凝聚,37,S. epidermidis do not form a clot-Transparence阴性液体状,S. aureus form a clot-solidfibrin gel, when grown in plasma. 阳性胶胨状,38,玻片法 Slide Test,39,2. 其他酶类,纤维蛋白溶酶：digests blood clots 激活纤维蛋白酶原纤维蛋白溶解扩散 耐热核酸酶：digests DNA and RNA 耐热核酸酶可作为测定葡萄球菌有无致 病性的重要指标之一。 透明质酸酶：to promote invasion 脂酶：分解脂肪和油类利于细菌定植 help bacteria colonize oily skin surfaces,40,成孔毒素，按抗原性不同，可分为、 、等类型，对人致病的主要是溶素。 Staphylolysin is kind of toxin that disrupt blood cell membranes. According to antigenicity, they are separated into many types such as 、 etc. The most far-reaching(深远的) in its biological effects is toxin.,3. 葡萄球菌溶素 Staphylolysin,41,3. 葡萄球菌溶素 Staphylolysin,特 点 成孔毒素，诱导细胞凋亡 多种哺乳动物红细胞有溶血作用 白细胞等多种组织细胞有损伤作用 damage RBC membrane, cytotoxic effects on phagocytes and other tissue cells 不耐热的蛋白质，经甲醛脱毒后可制 成类毒素。,42,Blood agar plate growing S. aureus.,two zones of hemolysis双层溶血现象,-hemolysis caused by -toxin,Zone of hemolysiscaused by -toxin,43,Na,7个溶素单体疏水部分形成桶形结构，插入细胞膜，形成直径2nm的小孔，使得Na流入，膜电位消失。,44,4. 杀白细胞素 Leukocidin,成孔毒素，攻击中性粒细胞和巨噬细胞，在抵抗宿主吞噬细胞，增强细菌侵袭力方面有意义. Leukocidin damages cell membranes of neutrophils and macrophages, causing them to lyse. This toxin probably helps to incapacitate(使无能力) the phagocytic line of defense.,45,5. 肠毒素 Enterotoxin,约50临床分离的金黄色葡萄球菌可产生肠毒素，有9个血清型。A、D型最多见。 Nearly 50% of S. aureus strains produce enterotoxins that act upon the gastrointestinal tract of humans. 9 serum types.,46,热稳定的可溶性蛋白质耐热100/30 min Heat-stableprotein,肠毒素性质,抵抗胃肠液中蛋白酶的水解作用Resistant to the action of gut enzymes,毒性强Ingestion of 1g/kg of enterotoxin results in vomiting and diarrhea.,超抗原是指那些不经过抗原递呈细胞的处理，便能与MHC类分子结合，直接活化某个T细胞亚群。因此可以激活5%20%的T细胞(传统0.00010.1)，导致释放大量细胞因子(IL-1、2、6、8，TNF 和 INF-等)，引发强烈的炎症反应。,47,毒素(食物),48,6.表皮剥脱毒素 Exfoliative Toxin,质粒、前噬菌体编码的超抗原毒素，裂开表皮上层细胞桥粒。引起烫伤样皮肤综合征。多见于新生儿、幼儿和免疫功能低下的成人。Exfoliative toxin separates the epidermal(表皮的)layer from the dermis(真皮) and causes the skin to peel away. This toxin is responsible for staphylococcal scalded skin syndrome(SSSS), in which the skin looks burned.,49,7. 毒性休克综合征毒素-1 (TSST-1) Toxic Shock Syndrome Toxin 1,引起机体发热、休克、脱屑性皮疹，并增加对内毒素的敏感性。The toxin enters the bloodstream and causes a series of reactions, including fever, vomiting, rash, and renal, liver, blood, and muscle involvement, which are sometimes fatal.,致病岛编码的超抗原毒素，感染后可引起机体多个器官系统的功能紊乱或毒性休克综合征。TSST-1 is the prototypical super-Ag which promotes the protean manifestations of the toxic shock syndrome (TSS).,50,二、致病性Part Pathogenesis,(二)、所致疾病,51,葡萄球菌在人体存在的部位及感染常发生的部位,1. 金葡菌常定居但不 引起感染部位2. 粉刺 、脓疱病3. 疖子、痈4. 脓肿5. 淋巴结败血症6. 骨髓炎7. 心内膜炎8. 脑膜炎9. 食物中毒10. 肾脏炎症11. 呼吸道感染,52,二、致病性Part Pathogenesis,侵袭性疾病毒素性疾病Depending on the degree of invasion or toxin productionby S. aureus, disease ranges from invasive diseases to toxigenic(产毒性) diseases.,53,1. 侵袭性疾病,葡萄球菌通过多种途径侵入机体，导致皮肤或器官化脓性感染，甚至全身感染。Staphylococcus usually invades the skin through wounds, follicles or skin glands, causes superficial(表皮的) inflammation, subcutaneous(皮下的) infections, organpyogenic(化脓性的) infection and systemic infection.,局部感染：疖，痈，毛囊炎，伤口化脓，脓疱疮, 中耳炎、肺炎等。 Localized cutaneous infections: furuncle, carbuncle, folliculitis impetigo, tympanitis, pneumonia etc.,全身感染：败血症，脓毒血症等。 Systemic InfectionsMost systemic staphylococcal infectionshave a focal pattern, spreading from a local cutaneous infection to other sites.,54,55,Superficial folliculitis(毛囊炎) in which raised, domed pustules(脓疱) form around hair follicles(毛囊).,56,Impetigo 脓疱疮staph skin infection, multiple pustules,57,A boil(疖) arises when a large abscess(脓肿) forms around a hair follicle.,58,A carbuncle (痈) consists of a multilocular(多囊泡的)abscess around several hair follicles.,59,60,61,食物中毒 Food intoxication,进食含葡萄球菌肠毒素食物后16小时出现症状，恶心、呕吐、腹痛、腹泻。大多数病人12天恢复。Ingestion of staphylococcal enterotoxinscontaminated food results in acute nausea, vomiting, abdominal pain and diarrhea within 1 to 6 hours, usually no fever. Recovery is rapid, usually within 1 to 2 days.,62,呕吐、发热、腹泻婴儿：海水样便,63,假膜性肠炎Pseudomembrane diarrhea,菌群失调性肠炎耐药性葡萄球菌繁殖肠毒素腹泻、肠粘膜覆盖炎性假膜During flora disequilibrium(失调) because the drug-susceptible microorganism are suppressed, the drug-resistant S. aureus proliferate(增生，扩散) and produce pseudomembrane diarrhea.,64,烫伤样皮肤综合征Scalded skin syndrome,多见于新生儿、免疫功能低下的成人表皮剥脱毒素红斑水泡大疤表皮上层脱落Upon reaching the skin, this toxin induces a painful, bright red flush over the entire body that first blisters and then causes desquamation of the epidermis.,65,66,烫伤样皮肤综合症,67,新生儿烫伤样皮肤综合症,68,成人烫伤样皮肤综合症,69,70,71,毒性休克综合征Toxic shock syndrome,毒性休克综合症毒素急性高热皮疹、呕吐、腹泻等 严重时出现休克Toxic shock syndrome is manifested by an abrupt onset of high fever, vomiting, diarrhea, myalgias, a scarlatiniform rash, and shock in the most severe cases.,72,三、免疫性Part Immunity,人类对葡萄球菌有一定的天然免疫力。患病后，能获得一定的免疫力，但不强，再次感染常见。Despite regular close contact throughout life, humans have a well developed resistance to staphylococcal infections.,73,幼猫试验,标 本,脓汁，血液，剩余食物，呕吐物等,触酶实验 血浆凝固酶 发酵甘露醇 耐热核酸酶,直接涂片染色镜检,生长现象,色素，溶血,生化反应,肠毒素检查,四、微生物检查法,革兰阳性葡萄球菌,药物敏感实验,分离培养,74,五 防治原则,防,注意消毒隔离,抗 生 素,自身菌苗疗法,防止医源性感染,防止耐药性产生,注意个人卫生,治,75,Produces an impressive array of(一批) virulence factors Cause both local, systemic infections and toxigenic diseases. Nosocomial (医院内) infection Problems in treatment,Pathogen Coagulase(凝固酶)+ Heat-stable nuclease(耐热核酸酶)+ Mannitol(甘露醇) + Coagulase negative staphylococcus CNS 凝固酶阴性与致病性,金葡菌引起化脓性感染的特点是： A.病灶易局限 B.可引起败血症、脓毒血症 C.可引起皮肤及脏器感染 D.可通过多种途径侵入机体,76,链球菌是另一大类常见的化脓性球菌。排列呈链状。分布广泛，多数是人体的正常菌群。The genus streptococcus includes a largegroup of bacteria. Some are normal residentsor agents of disease in humans; others are free-living in the environment. They areknown for the arrangement of cocci(球菌) inlong, beadlike(串珠状) chains.,链球菌属Streptococcus,Section 2,StreptococcusOverview,77,链 球 菌 分 类,溶血现象,抗原结构,氧的需要,甲型、乙型溶血性链球菌、丙型链球菌,多糖Ag：分群 共20群蛋白质Ag：群内分型,需氧、兼性厌氧、厌氧性链球菌,78,溶 血现 象,甲型溶血性链球菌溶血草绿色溶血环多为条件致病菌,乙型溶血性链球菌溶血完全透明溶血环致病菌致病力强,- hemolytic strain green pigmentopportunistic pathogen,- hemolytic strain transparent zonemajor pathogen,丙型链球菌 - strain无溶血环non-hemolytic一般不致病 normal flora,79,三种溶血现象,80,乙型溶血性链球菌,81,甲型溶血性链球菌,82,丙型链球菌,83,84,抗原结构,分20个群,A群致病菌（溶血性链球菌或化脓性链球菌）,根据蛋白抗原进一步分类M抗原,荚膜,细胞壁,蛋白质,多糖,肽聚糖,细胞膜,细胞质,1）多糖抗原（C抗原）群特异性抗原，细胞壁的多糖组分。,2）表面抗原或称蛋白质抗原:壁外的菌毛样结构含M蛋白,位于C抗原外层,具型特异性,有近100种血清型。M抗原与致病性有关。,3）P抗原或称核蛋白抗原:无特异性。,85,链球菌的三种主要抗原: Streptococci display numerous antigens. 蛋白质表面抗原 Protein surface-Ag 与致病性相关的是A群中的M蛋白，型特异性。A major virulence factor is M-protein, type-specific molecule 细胞壁群特异性多糖Ag C-Ag Cell wall grope-specific polysaccharid Ag 核蛋白抗原，无特异性 Nucleoprotein,86,多糖抗原,AH、KV 共20群,A,致病性链球菌株， 90%左右属A群。,87,一、A群链球菌 Group A Streptococcus,88,一、生物学性状Part Biological Properties,1. 形态染色 Morphology and Stain,球形、卵圆形，链状排列， G+Spherical or oval, arranged in chains, G+ 无芽胞、荚膜，早期培养有荚膜non-spore-forming and nonmotile，they can form capsules.,89,Spherical or oval, arranged in chains,(33,000 ),(x56,000),(x1,000),(x1,000),90,一、生物学性状Part Biological Properties,2. 培养及生长特性 Culture and Growth characteristics,营养要求较高（血液、血清），多数兼性厌氧菌，触酶(-)，菊糖(-) ，不被胆汁溶解。enriched media for cultivation，facultative anaerobes，catalase(-)，inulin (-), bile solubility test (-).,血平板上，形成灰白色、表面光滑、边缘整齐的细小菌落。On blood agar, colonies are usually small, nonpigmented and glistening.,91, flesh (meat) eating“ bacteria,乙型溶血性链球菌菌落,92,一、生物学性状Part Biological Properties,93,二、致病性Part Pathogenesis,94,细胞壁成分磷壁酸、M蛋白肽聚糖、细菌胞壁受体、F蛋白,外毒素 致热外毒素、链球菌溶素,侵袭性的酶 透明质酸酶、链激酶、链道酶,(一)、致病物质Pathogenic Substances,二、致病性Part Pathogenesis,95,脂磷壁酸,96,97,M 蛋白 M Protein,超抗原，有100多种血清型。抗吞噬，抗吞噬细胞内的杀菌作用。与某些超敏反应疾病有关。M-protein is the main component of fimbriae(菌毛), the spiky(大钉状的)surfaceprojections that contribute to virulenceby resisting phagocytosis (吞噬作用)andimproving adherence. M-protein relates to hypersensitivity disease.,98,心 肌,Unfortunately Certain M protein types,Cross-reactive,肾小球基底膜,99,致热外毒素 pyrogenic exotoxin,人类猩红热的主要毒性物质Pathogenic substances of Scarlet Fever 带有溶原性噬菌体的A群链球菌产生From S. pyogenes that carries a lysogenicbacteriophage 热稳定蛋白质 Heat stable protein,动物实验兔 致死性、致热性 增加内毒素休克的敏感性 培养的脾细胞、巨噬细胞 毒性 改变血脑屏障的通透性 发热反应 毒性休克综合症,100,链球菌溶素 Streptolysin,Streptolysin hemolyze red blood cell 溶解红细胞 damage blood platelet 损伤血小板,streptolysin O SLO,streptolysin S SLS,O2,101,SLO-Ab风湿热及其活动性的辅助诊断,“巯基激活”-SH-S-S-成孔毒素,Liver Heart muscleetc.,中性粒细胞巨噬细胞神经细胞,SLO,O2敏感O2 Sensitive,对多种细胞有毒性作用Injure many cells,对多种组织有毒性作用Injure manytissues,SLO-Ab链球菌新近感染指标之一,102,SLS,O2不敏感O2 Stable,无免疫原性No antibodies,103,SLS ?,SLO ?,Colonies of Streptococcus pyogenesshowing -hemolysis.,乙型溶血性链球菌,104,透明质酸酶 Hyaluronidase,透明质酸酶 扩散因子分解细胞间质的透明质酸，使病菌在组织中易扩散。扩散因子。Hyaluronidase breaks down the bindingsubstance in connective tissue and promotes spreading of the pathogen into the tissues.,Hyaluronidaseplays a role in invasion !,105,链激酶 Streptokinase SK,纤维蛋白酶原,纤维蛋白酶,链激酶,利于细菌扩散,SKplays a role in invasion !,106,链道酶 Streptodornase SD,链道酶 链球菌DNA酶降解脓液中的DNA，使脓液稀薄，有利于病菌扩散。DNase discharges by hydrolyzing(水解) DNA，liquefies(液化) purulent.,DNase plays a role in invasion !,107,二、致病性Part Pathogenesis,二、所致疾病,108,109,二、致病性Part Pathogenesis,化脓性感染 皮肤和皮下组织感染其他系统感染中毒性疾病 猩红热链球菌毒素休克综合征超敏反应性风湿热急性肾小球肾炎,110,蜂窝织炎一种皮下组织或相连组织的扩散性炎症,111,Impetigo lesions on the face脓疱病脓疱病：一种儿童常患的传染性皮肤链球菌感染，其特征为表皮小脓疱的发作和黄色厚的硬皮的形成，通常出现在脸部。,112,Erysipelas of the face. 丹毒：由一种溶血性链球菌引起的皮肤或皮下组织突发性疾病，症状是局部发炎、发烧,113,Erysipelas 丹毒Notice the lesion at the site of initial entry (white arrow) and the spread of the inflammation to the foot. 白色箭头所指原发感染部位，炎症向足部扩展。,114,The appearance of the throat in pharyngitis(咽炎) tonsillitis(扁桃腺炎),115,Scarlet Fever 猩红热The strawberry-colored tongue of this streptococcal disease.溶血性链球菌引起的一种急性传染病，主要出现在儿童中，特征为皮肤红疹和高烧。,116,Scarlet Fever 猩红热,117,Rheumatic fever 风湿热Pathologic processes of group A streptococcal infection can extend to the heart. Inset reveals scar tissue on a damaged mitral valve. 一种严重的传染性疾病，症状为发烧、关节疼痛及导致对心脏瓣膜的永久性损伤,118,三、免疫性Part Immunity,机体可建立对同型 链球菌的特异性免疫！,能建立牢固的同型抗毒素 免疫但链球菌型别多，各 型间无交叉免疫力， 故常可反复感染。,119,四、微生物学检查法Part Diagnosis,标本 Specimens A throat swab, pus, or blood 直接涂片镜检 Smears microscopySmears from pus often show single cocci or pairs rather than definite chains.分离培养与鉴定 Culture Detection Tests,链球菌溶血素O试验，用于风湿热的辅 助诊断。 Serologic Tests - Antistreptolysin O test,120,五、防治原则Part Treatment,减少传染源注意消毒治疗患者以青霉素G为首选药物，须 治疗彻底，防止超敏反应性疾病的发生,121,According to hemolysis(溶血) -hemolytic strain-opportunistic pathogen -hemolytic strain-major pathogen -strain-normal flora Catalase-negative 过氧化氢酶阴性,3 Kinds pathogenic substances Cell wall components 细胞壁成分 Extracellular Toxins外毒素 Invasive factors侵袭性物质,3 types diseases Suppurative Diseases 化脓性 Toxigenic diseases 中毒性 Hypersensitivity disease 超敏性,链球菌化脓性病灶脓汁稀薄且易扩散， 其主要原因是病原菌产生： A. 透明质酸酶 B. 血浆凝固酶 C. 链激酶 D. 链道酶,122,二、肺炎链球菌Streptococcus Pneumonia(Pneumococcus),123,一、生物学性状Part Biological Properties,1. 形态染色 Morphology and Stain,菌体矛头状，成双排列， G+ lancet-shaped diplococci, G+ 无芽胞、鞭毛，致病菌株形成荚膜non-spore-forming and nonmotile，all pathogenic strains form rather large capsules.,124,肺炎链球菌 (1000),125,肺炎链球菌 (1000),126,肺炎链球菌 56,000,127,一、生物学性状Part Biological Properties,2. 培养及生长特性 Culture and Growth characteristics,营养要求较高，兼性菌，enriched media for cultivation，facultative anaerobes,血平板上，形成灰白色、半透明的细小菌落。草绿色溶血环。On blood agar, colonies are usually small, offwhite(灰白色), translucence, -hemolysis.,自溶现象 孵育超过48h，产生大量自溶酶，菌体自溶，菌落中央下陷呈脐状。produce enzyme undergo autolysis, forming a central plateau with an elevated rim.,128,肺炎链球菌草绿色()溶血环,129,一、生物学性状Part Biological Properties,3.生化反应 Biochemical Reaction,注意与甲型链球菌的区别！ 菊糖发酵实验 胆汁溶菌实验 奥普托辛实验 (乙基氢化叩卜林 ),130,菌液,+,胆汁,37 ,10min,混浊,澄清,甲型溶血性链球菌,肺炎链球菌,131,胆汁溶菌实验Bile solubility test,+,132,奥普托辛 敏感,奥普托辛 不敏感,肺炎链球菌,甲型溶血性链球菌,37 48小时,133,一、生物学性状Part Biological Properties,荚膜多糖 Ag 84个血清型 Capsule Polysaccharide Ag菌体抗原 C多糖 M蛋白,4. 抗原结构 Ag structure,134,二、致病性Part Pathogenesis,致病物质Pathogenic Substances,135,大叶性肺炎pneumococcal pneumonia lobar(肺叶的) pneumonia,所致疾病,二、致病性Part Pathogenesis,136,三、微生物学检查Part Laboratory Diagnosis,标本病种直接涂片镜检 分离培养与鉴定 肺炎链球菌的鉴定,137,四、防 治 原 则Part Treatment,138,奈瑟菌属是革兰阴性双球菌。无鞭毛。无芽胞。有菌毛。需氧，具有氧化酶和触酶。Members of the family neisseriaceae areresidents of the mucous membranes. Mostspecies are commensals(共生物), but two are primary human pathogens.,奈瑟菌属Neisseria,Section 3,NeisseriaOverview,139,淋病奈瑟菌 N. gonorrhoeae 寄生于尿道粘膜,脑膜炎奈瑟菌 N. meningitidis 存在于鼻咽腔粘膜,140,一、脑膜炎奈瑟菌 N. meningitidis,脑膜炎奈瑟球菌脑膜炎球菌流行性脑脊髓膜炎的病原体pathogen of cerebrospinal meningitis,一、脑膜炎奈瑟菌 N. meningitidis,141,一、生物学性状Part Biological Properties,142,形态与染色肾形或豆形革兰阴性双球菌，凹面相对，新分离菌株大多有荚膜和菌毛。G-, bean-shaped and paired, withtheir concave(凹的) sides touching, non-motile, none spore, withcapsule and pili.,在病人脑脊液中，多位于中 性粒细胞内，常四个在一起。,脑膜炎奈瑟球菌 革兰染色 1000,143,脑膜炎奈瑟球菌 (56,000),144,营养要求高，最常用巧克力平板培养，专性需氧，初次分离培养需要 5%10% CO2。产生自溶酶，培养超过48小时常死亡。N.meningitidis, require complex enriched media such as heated blood, hemin etc. , and grow best on media containi