肺炎链球菌PPT课件

-,1,Chapter8球菌（coccus）,pyogeniccocci化脓性球菌G+:Staphylococcus葡萄球菌、Streptococcus链球菌、enterococcus肠球菌G-:N.meningitidis脑膜炎奈瑟菌，N.gonorrhoeae淋病奈瑟菌noflagellum,nospore,-,2,葡萄球菌属（staphylococci）,MorphologyTypicalOrganismsGrampositivesphericalcells革兰阳性球菌grape-likeclusters葡萄串状,-,3,culture,growreadilyonmostmediaOrdinaryplate普通平板Bloodplate血平板Coloniesround,smoothraised,andglisteningformpigment色素goldenyellow金黄色whitelemonyellow柠檬黄有些菌溶血产生溶血环(hemolyticzones),-,4,Biochemistryreaction,触酶阳性多数菌分解葡萄糖、麦芽糖和蔗糖，产酸不产气致病菌分解甘露醇,-,5,Antigenicstructure抗原构造,-,6,SPA（staphylococcalproteinA）ProteinAisasurfaceproteinofSaureuswhichbindsIgG1,IgG2,andIgG4moleculesbytheirFcregion.,本质：单链多肽（细胞壁上与肽聚糖结合）90%以上的金葡菌有特性：与人和一些动物IgG1，IgG2，IgG4的FC段非特异性结合。意义：致病作用-与抗体结合后有抗吞噬，促细胞分裂、超敏反应等作用。协同凝集试验-利用含SPA的葡萄球菌作为载体，用于多种微生物抗原检出。,-,7,classificaion,色素、生化反应金黄色葡萄球菌（S.aureus）表皮葡萄球菌（S.epidermidis）腐生葡萄球菌（S.saprophyticus）有无凝固酶凝固酶阴性葡萄球菌（Coagulasepositivestaphylococcus)凝固酶阳性葡萄球菌（Coagulasenegativestaphylococcus),-,8,（致病性葡萄球菌的鉴别）,-,9,Resistance抵抗力,Theirresistanceisstrongestamongnonspore-formingbacteria对外界因素的抵抗力强于其他无芽孢菌sensitivetoalkalidyes对碱性染料敏感（龙胆紫）drug-resistance耐药性,MRSA,-,10,Pathogenesis&ImmunityVirulenceFactors致病物质,表面结构Enzymes酶Coagulase血浆凝固酶thermostabledeoxyribonuclease耐热核酸酶Toxins毒素staphylolysin葡萄球菌溶素leukocidin杀白细胞素Toxicshocksyndrometoxin-1毒性休克综合征毒素-1Enterotoxins(AtoE)肠毒素Exfoliativetoxin表皮剥脱毒素,-,11,coagulase凝固酶,概念使含有抗凝剂的人或兔血浆发生凝固的酶类物质游离凝固酶freecoagulase结合凝固酶boundcoagulase意义鉴别有无致病性的重要指标致病机理：抵抗吞噬细胞的吞噬保护病菌不受血清中杀菌物质的破坏感染局限化和形成血栓,-,12,表皮剥脱毒素（exfoliativetoxin）,引起机体发热，增加对内毒素的敏感性可引起多个器官系统的功能紊乱或毒性休克综合征（TSS）引起烫伤样皮肤综合征（staphylococcalscaldedskinsyndrome，SSSS）,毒性休克综合征毒素-1（TSST-1）,-,13,肠毒素（enterotoxin）,约1/3临床分离金黄色葡萄球菌可产生引起急性胃肠炎，即食物中毒heat-stable(resistboilingfor30)耐热resistanttotheactionofgutenzymes抗胃肠液中蛋白酶作用机制：刺激呕吐中枢导致以恶心呕吐（nauseaandvomiting）为主要症状的食物中毒,-,14,Clinicalfindings：,-,15,Coagulase-negativeStaphylococcusspecies凝固酶阴性葡萄球菌CNS,Urinarytractinfection泌尿系统感染septicemiaopportunisticinfections,-,16,Immunity,人类有一定的天然免疫力感染后能获得一定的免疫力，但不强,-,17,ELISA小猫试验,DiagnosticLaboratoryTests微生物检查法,标本,脓汁，血液，剩余食物，呕吐物等,分离培养,血浆凝固酶发酵甘露醇耐热核酸酶,直接涂片镜检,革兰阳性葡萄串状球菌,生长现象,色素，溶血,生化反应,毒素检查,-,18,Prevention&Treatment防治,防,注意消毒隔离,注意个人卫生,防止医源性感染,防止耐药性产生,治,抗生素药敏试验,自身菌苗疗法,-,19,Streptococci链球菌属,Grampositivesphericalorovoidcells,arrangedinchainsordiplococci双球菌,lancet-shaped矛头状：平面相对尖面相背,Streptococcuspneumoniae(pneumococcus)肺炎链球菌（肺炎球菌）,-,20,Culture培养特性：,growthrequiresbloodLiquidmedium:sedimentinbottom液体培养为沉淀生长血平板呈灰白色表面光滑小菌落，一些菌株产生溶血素（不同菌株溶血不一）肺炎链球菌:autolysin自溶酶,-,21,生化反应,分解葡萄糖除肺炎链球菌外，不分解菊糖，不被胆汁溶解（鉴别甲型溶血性链球菌与肺炎链球菌）,-,22,.Antigenicstructure抗原构造,多糖抗原（C抗原）表面蛋白抗原型特异性M、T、R、S核蛋白抗原S.pneumoniae荚膜多糖抗原Thecapsularpolysaccharideisimmunologicallydistinctforeachofthemorethan85types.根据荚膜多糖抗原不同，至少可分为85个型别。,分20个群，A群致病菌(溶血性链球菌或化脓性链球菌）,classification分类,根据蛋白抗原进一步分型,-,23,.Hemolysisonbloodagar根据溶血现象分类,-,24,Pathogenesis致病性,GroupAStreptococcusVirulenceFactors致病物质,StructuralComponents结构成分：Mprotein，Fprotein，LTA脂磷壁酸Enzymes酶：Hyaluronidase透明质酸酶Streptodornase链道酶Strpetokinase链激酶Collagenase胶原酶Toxins毒素Pyrogenicexotoxins:致热外毒素StreptolysinO、S链球菌溶素O、S,-,25,F蛋白（proteinF）,Itmediatesadherence粘附toepithelialcells上皮细胞有抗吞噬和抗吞噬细胞内杀菌作用与某些超敏反应疾病有关,rheumaticfever风湿热,M蛋白,-,26,Hyaluronidase透明质酸酶,spreadingfactor扩散因子splitshyaluronicacid透明质酸spreading扩散,链激酶（streptokinase；SK）链道酶（streptodornase；SD）,-,27,链球菌溶素（streptolysin）,SLO：Itisrapidlyinactivatedinthepresenceofoxygen.对O2敏感。Anantibody,antistreptolysinO,appearsinhumanfollowinginfectionwithanystreptococcithatproducestreptolysinO.感染产生链球菌溶素O的链球菌后出现抗链球菌溶素O抗体。测定SLO抗体含量，可作为链球菌新近感染指标之一或风湿热及其活动性的辅助诊断SLS：Itisoxygen-stable.对O2稳定hemolyticzones溶血环,-,28,致热外毒素（pyrogenicexotoxin，SPE）,Erythrogenictoxin红疹毒素，scarletfevertoxin猩红热毒素A群链球菌溶原菌菌株产生scarletfever猩红热,-,29,Clinicalfindings所致疾病：,GroupAStreptococcusA群链球菌,lymphangitis淋巴管炎,scarletfever猩红热,Poststreptococcalallergicdiseases超敏反应性疾病,Pyogenicinfection化脓性感染,Toxicdisease中毒性疾病,cellulites蜂窝组织炎nasosinusitis鼻窦炎tonsillitis扁桃体炎,rheumaticfever风湿热,acuteglomerulonephritis急性肾小球肾炎,-,30,Virulencefactors致病物质：,S.pneumoniae,capsule荚膜,Pathology所致疾病：,Lobarpneumonia大叶性肺炎,-,31,Sreptococcusviridans草绿色链球菌（-hemolyticstreptococcus）甲型链球菌,subacutebacterialendocarditis亚急性细菌性心内膜炎,dentalcaries龋齿,Neonatalinfections(meningitis,pneumonia,bacteremia)新生儿感染（脑膜炎、肺炎、菌血症）,GroupBstreptococcus/GBSB群链球菌(Sreptococcusagalacitae无乳链球菌),-,32,immunity免疫性,可刺激机体产生各种抗体抗M蛋白抗体有保护作用型别间无交叉免疫猩红热患者可建立牢固的同型抗毒素免疫,肺炎链球菌建立同型免疫，产生型特异的荚膜多糖抗体,-,33,DiagnosticLaboratoryTests微生物学检查法,标本,直接涂片镜检,革兰阳性链球菌,分离培养,脓汁，血液，咽喉拭子,甲型链球菌与肺炎链球菌的鉴别,菊糖分解试验胆汁溶菌试验Optochin敏感试验动物试验,-,34,血清学检查,抗链球菌溶素O试验：抗O试验（ASOtest）,-,35,Prevention&Treatment积极治疗儿童链球菌感染肺炎链球菌：capsularpolysaccharidesvaccine荚膜多糖疫苗选用青霉素,-,36,Neisseria奈瑟菌属,Gramnegative，aerobicdiplococci革兰阴性需氧双球菌,N.gonorrhoeaeandN.meningitidis淋病奈瑟菌和脑膜炎奈瑟菌,-,37,N.meningitidis（meningococcus)脑膜炎奈瑟菌,kidney-shaped肾形,-,38,Culture,aerobicbacteria专性需氧菌58CO2enrichedmedia：heatedbloodagar(“chocolate”agar)巧克力（色）培养基autolysin,-,39,AntigenicStructure抗原构造,groupedonthebasisoftheircapsularpolysaccharides荚膜多糖群特异性抗原分群ThemostimportantserogroupsassociatedwithdiseaseinhumanareA,B,C,Y,andw-135,Resistance抵抗力,veryweak很弱,四怕热寒冷干燥消毒剂,-,40,Pathogenesis致病性,Pathogenicsubstances致病物质:capsule,piliandLOS荚膜、菌毛、脂寡糖,Pathology所致疾病,meningitis流行性脑脊髓膜炎Thenasopharynx鼻咽istheportalofentry.Symptom：intenseheadache,vomiting,stiffneck,andcoma头痛、呕吐、颈部强直、昏迷,三种临床类型普通型、爆发型、慢性败血症型,-,41,Immunity：antibodiesintheserum血清中的抗体,-,42,DiagnosticLaboratoryTests微生物学检查,Specimens标本,culture培养,blood,spinalfluid脑脊液,andpuncturematerialfrompetechiae淤斑渗出液、nasopharyngealswab鼻咽拭保暖、保湿、立即送检，培养基预温,Smears直接涂片镜检,typicalneisseriaewithinpolymorphonuclearleukocytesorextracellilarly中性粒细胞内、外有革兰阴性双球菌,heatedbloodagar(“chocolate”agar)巧克力（色）培养基,Rapiddignose快速诊断,counterimmunoelectrophoresis对流免疫电泳SPAcoagglutinationSPA协同凝集试验,-,43,Prevention&Treatment防治原则,childrencapsularpolysaccharidevaccines荚膜多糖疫苗,TreatmentPenicillin,-,44,N.gonorrhoeae(gonococcus)淋病奈瑟菌,Beanshaped，usuallyseeninpairswithadjacentflattenedsides.平面相对，成对排列,-,45,pili菌