医学微生物课件

1、医学微生物课件医学微生物课件医学微生物课件掌握：1.结核分枝杆菌的形态染色、培养特性、抵抗力、致病机理、结核菌素试验的原理与用途、微生物学检查法、卡介苗预防；2.麻风分枝杆菌的形态染色、致病特点。熟悉：结核分枝杆菌的免疫与变态反应关系。2020/11/32医学微生物课件医学微生物课件医学微生物课件掌握：掌握：1.结核分枝杆菌的形态染色、培养特性、抵抗力、致病机理、结核菌素试验的原理与用途、微生物学检查法、卡介苗预防；2.麻风分枝杆菌的形态染色、致病特点。熟悉：结核分枝杆菌的免疫与变态反应关系。2020/11/32掌握：2020/11/32Common features aerobic, ina

2、bility to be Gram-stained Lipid-rich cell wall,especially mycolic acid分枝菌酸，resist decolorization with acid-alcohol after stained with carbolic fuchsinacid-fast stain, acid-fast rods.2020/11/33Common features aerobic, 2020/细长略弯的杆菌，有分枝生长趋势；细胞壁含大量脂质、不易着色，染色后可抵抗盐酸乙醇脱色，抗酸杆菌。 2020/11/34细长略弯的杆菌，有分枝生长趋势；202

3、0/11/34M.Tuberculosis bacillus complex 结核分枝杆菌复合群 生长缓慢，包括人和牛结核分枝杆菌2. Nontuberculous mycobacteria 非结核分枝杆菌3. M.leprae麻风分枝杆菌分枝杆菌的分类classify2020/11/35M.Tuberculosis bacillus compleAcid Fast Stain(Ziehl-Neelsen stain)Stain the slide with carbol fuchsin 石炭酸复红(a red dye) Decolorize it with 3% hydrochloric a

4、cid盐酸酒精 (acid-alcohol) . counter-stain with methylene blue.美蓝 The Lipid especially mycolic acid can resist to decolorization with acid-alcohol after stained with carbol fuchsin2020/11/36Acid Fast Stain(Ziehl-Neelsen抗酸染色阳性抗酸染色阴性固定5石炭酸复红3盐酸酒精美蓝2020/11/37抗酸染色阳性抗酸染色阴性固定5石炭酸复红3盐酸酒精美蓝2Mycobacterium stains

5、 red other bacterium and the background stains blue. Acid Fastness Stain(Ziehl-Neelsen stain)2020/11/38Acid Fastness Stain(Ziehl-Nee2020/11/392020/11/392020/11/3102020/11/310 PathogensMycobacterium tuberculosisMycobacterium leprae2020/11/311 Pathogens2020/11/311 Mycobacterium tuberculosisacid-fast s

6、tain2020/11/312 Mycobacterium tuberculosis2022020/11/3132020/11/3139岁，男孩，因发热，咳嗽咳痰入院，胸部X光检查可见肺部有哑铃状阴影（原发综合征表现）： （1）你认为该儿童得的是什么病？（2）为了明确诊断，你会对他做哪些微生物学检查？2020/11/3149岁，男孩，因发热，咳嗽咳痰入院，胸部X光检查可见肺部有哑铃第一节结核分枝杆菌 Mycobacterium tuberculosis （tubercle bacilli ）。2020/11/315第一节结核分枝杆菌 Mycobacterium tubeMorphology t

7、hin and slightly cur rods acid-fast bacilli2020/11/316Morphology2020/11/316形态染色： 细长略弯的杆菌，常聚集成团。2020/11/317形态染色：2020/11/317 抗酸染色法：分枝杆菌呈红色，其它菌及背景为蓝色。2020/11/318 抗酸染色法：分枝杆菌呈红色，其它菌及背景为蓝色。20Mycobacterium tuberculosis2020/11/319Mycobacterium tuberculosis20201.obligate aerobic. mycoderm菌膜2.nutrition are hi

8、gh, Lowenstein-Jensen medium 3. It grows very slow with a generation time of 18 hours. colony ,3-4 weeks4.The rough colonies granular, dull- yellow, dryCulture 2020/11/3201.obligate aerobic. mycoder培养特性：1、专性需氧。 液体培养基中形成mycoderm菌膜， 索状生长。 3、营养要求高，罗氏培养基。 4、生长缓慢。 5、菌落呈颗粒、结节或花菜状， 乳白或米黄色，不透明。 2020/11/321培

9、养特性：1、专性需氧。2020/11/3212020/11/3222020/11/3222020/11/3232020/11/3232020/11/3242020/11/3242020/11/3252020/11/325ResistanceResistant dry (sputum)Relatively resistant to acids and alkaliResistant to the main antimycobacterial drug drug resistanceSensitive to ultra-violet light ,heat , and alcohol 2020/1

10、1/326ResistanceResistant dry (sput抵抗力： 干燥 抵抗力强 酸、碱 乙醇、湿热、紫外线 药物敏感，但易耐药结核分枝杆菌敏感有抵抗力2020/11/327抵抗力： 干燥 抵抗力强结核分枝杆菌VariationShape VariationColony VariationVirulent VariationDrug resistance Variation2020/11/328VariationShape Variation2020/1PathogenicityA.Constituents of Tubercle Bacilli no toxinssurvive

11、and multiplies within cells2020/11/329PathogenicityA.Constituents o二、致病性（一）致病物质1、脂质：(1) Cord factor索状因子：抑制白细胞游走，与慢性肉芽肿形成有关。 (2) Phosphatides磷脂：促使单核细胞增生Tb结节形成，干酪样坏死。结核分枝杆菌2020/11/330二、致病性（一）致病物质结核分枝杆菌2020/11/330(3) Wax D蜡质D：有佐剂作用，激发机体产生迟发型变态反应。(4) Sulfatide硫酸脑苷脂：使Tb杆菌在吞噬细胞中大量存活。2020/11/331(3) Wax D蜡质

12、D：有佐剂作用，激发机体产生迟发型变态 2. Several proteins When combined with wax D, elicit delayed hypersensitivity (tuberculin reaction) 3. Polysaccharides 2020/11/332 2020/11/3322、蛋白质：Tb菌素蜡质D -迟发型超敏反应3、多糖2020/11/3332020/11/333Several complex lipidsPhosphatides 磷脂: play a role in caseous necrosisCord factor： Correla

13、ted with virulence of the organism Inhibits migration of leukocytes ,causes chronic granulomas ,can serve as adjuvantSulfatide硫酸脑苷脂 suppress phagosome combine with lysosomeWax D: adjuvant, used to enhance the immune response2020/11/334Several complex lipidsPhosphatMycobacterium tuberculosisDiseases

14、tuberculosis approximately one third of the worlds population is infected2020/11/335Mycobacterium tuberculosisDisePathogenesis primary infection1) lung infection secondary infection 2) Out lung infection :intestines肠、肾kidney、bone、brain, joint , and so on. 2020/11/336Pathogenesis2020/11/336Occur in t

15、he lungsno immunity (children )Ghon complex: (Ghon focus)（survive and multiplies within macrophage） initial lesion and enlarged hilar lymph nodes90 % heal but a few bicillin in lung Some bacilli diffusion primary Tuberculosis2020/11/337Occur in the lungsprimary Tube1、肺部感染：肺结核最多见（1）原发感染 Tb杆菌肺泡大量繁殖肺泡内

16、炎症(原发灶)Tb杆菌通过淋巴管到肺门淋巴组织肺门淋巴结肿大(原发综合征)自愈(钙化、纤维化)（约90%）。少数免疫力低下者，经血流播散 全身结核病2020/11/3381、肺部感染：肺结核最多见（1）原发感染2020/11/33post-primary TuberculosisAdultsectogenous infection or autogenous infection Focus of infection are limitedCavity formation2020/11/339post-primary TuberculosisAdult（2）原发后感染： 可为外源性或内源性感染，

17、肺部多见，病灶局限，一般不累及邻近的淋巴结。易形成空洞。 2020/11/340（2）原发后感染： 可为外源性或内源性感染，肺部多见，病Cavity formation2020/11/341Cavity formation2020/11/341肺部感染：肺结核原发结核：外源性感染多发生于儿童（无免疫力）原发综合征 ( 肺门淋巴肿大等)形成结核结节（即结核肉芽肿），少数病灶扩散，引起全身TB转归原发后结核：外或内源性感染多见成人病灶局限 引起局部TB、开放性TB（反应剧烈，干酪性坏死、空洞）2020/11/342肺部感染：肺结核原发结核：外源性感染2020/11/342肺结核病的主要症状有：co

18、ugh咳嗽、咳痰spit blood咯血、chest pain胸痛fever in afternoon、 fatigue疲乏无力、anorexia食欲减退 、lose flesh消瘦、night sweats夜间盗汗、2020/11/343肺结核病的主要症状有：2020/11/343Immunity and hypersensitivityResistance mainly by cellular immunityHigh rate of infection, but low morbidity.2020/11/344Immunity and hypersensitivityRImmunity

19、 and hypersensitivityCellular immunity and hypersensitivity exist simultaneouslykoch phenomenonInject subcutaneously TB into guinea pig 2020/11/345Immunity and hypersensitivityCInfected animalNormal animal24-48h10-14dLocal red swellingSuperficial ulcerLocal flare, deep ulcer not diffusion,heal rapid

20、lyNecrosis, heal slowly 有毒TB菌Diffusionsubcutaneously郭霍现象2020/11/346Infected animalNormal animal24(二)免疫与变态反应：郭霍现象：原发感染特点：初次感染结核杆菌，10-14天局部出现溃疡，深,不易愈合；附近淋巴结肿大，细菌易扩散。原发后感染特点：再次感染结核杆菌，1-2天局部出现溃疡，浅,易愈合；附近淋巴结不肿大，细菌不扩散。感染免疫变态反应三者同时存在2020/11/347(二)免疫与变态反应：郭霍现象：感染免疫变态反应三者同初次注射 局部反应小 全身扩散 无免疫无超敏反应再次注射 局部反应大 不

21、扩散 有免疫有超敏反应2020/11/3482020/11/348Tuberculin skin testDue to a delayed hypersensitivity reactionOT PPD: antigen, contain 5 tuberculin unitsEvaluated by measuring the diameter of the induration surrounding the test site 2020/11/349Tuberculin skin testDue to a (三)结核菌素试验：1、原理： 应用结核菌素进行皮肤试验测定机体对结核分枝杆菌是否引

22、起超敏反应的一种试验。2020/11/350(三)结核菌素试验：1、原理： 2020/11/350Mantoux method When the Mantoux skin test is performed, a needle is injected into the upper skin layer of the patients arm. The arm is examined 48 to 72 hours after the tuberculin injection in order to evaluate the reaction on the patients skin. Any s

23、welling that can be felt around the site of the injection, also known as induration, is measured. The diagnosis of TB infection depends on the size of the measured induration and the patients individual risk factors.2020/11/351Mantoux method When th2、结核菌素： 旧结核菌素(OT)：结核菌菌体蛋白,纯蛋白衍化物(PPD)3、试验方法： 常规试验取P

24、PD5u注射两前臂皮内，4872小时后观察结果2020/11/3522、结核菌素： 旧结核菌素(OT)：结核菌菌体蛋白,positive ：Induration 5 mm caused by a delayed hypersensitivity response Indicates previous infection but not necessarily active diseaseresult2020/11/353positive ：Induration 5 mm resstrong positive (+):Induration 15 mm , diagnosis of infant

25、tuberculosis.negative(-) Induration 5mm or no Induration :no infection and no immunity2020/11/354strong positive (+):no infecnegative(-)：In the early days of infectionThe agedOverwhelming tuberculosis or other diseaseAIDS2020/11/355negative(-)：2020/11/355 4、结果观察及意义(1)阳性：局部红肿、硬结5mm,感染免疫变态反应。(2)强阳性：局部

26、红肿、硬结15mm，有诊断意义。(3)阴性：局部无反应或硬结5mm未感染过结核杆菌。2020/11/356 4、结果观察及意义(1)阳性：局部红肿、硬结5mm,感染 a、感染初期。 b、老年人。 c、严重结核病患者或正患其他 传染病。 d、获得性细胞免疫低下。阴性者应考虑几种情况：2020/11/357 a、感染初期。阴性者应考虑几种情况ApplicationSelect BCG vaccination object, detect effect of immunization.Epidemiological investigation.Auxiliary diagnosis of infan

27、t tuberculosis.Evaluate cellular immunity of tumor patients.2020/11/358ApplicationSelect BCG vaccinat5、应用：(1)选择卡介苗接种对象及免疫效果测定。(2)婴幼儿Tb病诊断参考、结核的疗效判断。(3)测定肿瘤患者非特异性细胞免疫功能。(4)未接种卡介苗人群中调查结核病流行情况。2020/11/3595、应用：(1)选择卡介苗接种对象及免疫效果测定。2020/Laboratory diagnosis1. Specimen: sputum, pus, CSF, urine, etc. 2. Mic

28、roscopic examination: Ziehl-Neelsen stain3. Concentration: 4%NaOH-3%HCL; 6% H2SO44. Culture: solid culture (2-4 weeks 37) ; liquid culture (1-2 weeks)5. Animal inoculation: guinea pig6. quick Diagnosis: PCR 2020/11/360Laboratory diagnosis1. Specime微生物学检查1、标本：根据感染部位选材，某些部位标本应先集菌，如离心或消化。2、直接涂片镜检：抗酸染色。

29、3、分离培养。4、动物试验。5、快速诊断。2020/11/361微生物学检查1、标本：2020/11/361PreventionVaccineBCG vaccination for new infants 2020/11/362PreventionVaccine2020/11/362Treatment for TuberculosisTreated with a combination of multiple drugs for a long period of time: rifampin, isoniazid (INH), pyrazinamide, ethambutol, and str

30、eptomycin.Emergence of multi-drug resistant M. tuberculosis strains.2020/11/363Treatment for TuberculosisTrea treatment multiple-drug, long-term therapy (6-9 months) Three drugs: isoniazid , rifampin,(6 m) and pyrazinamide(2 m) ethambutol: used in severe cases and isoniazid-resistant(all for 9-12 m)

31、2020/11/364 treatment multiple-drug, 结核分枝杆菌的形态染色、培养特点。结核杆菌的免疫特点？什么叫结核菌素试验？其原理是什么？结果有何意义？试述结核杆菌的微生物学检查方法。2020/11/365结核分枝杆菌的形态染色、培养特点。2020/11/365Mycobacterium lepraeDisease leprosy2020/11/366Mycobacterium lepraeDisease202HANSENS DISEASE (Leprosy) caused by M. lepraeHansens disease is a chronic, slowly

32、 progressive granulomatous disease involving ectodermally derived tissue such as the skin and peripheral nerves. The disease is usually limited to the cooler parts of the body such as the skin, nose and upper respiratory tract. It rarely affects internal organs such as the brain, liver, spleen, kidn

33、eys, and bones. It has a specific predilection for peripheral nerves.2020/11/367HANSENS DISEASE (Leprosy) cCharacteristics aerobic, acid-fast rods cant be cultured in vitro 2020/11/368Characteristics aerobic, ac 麻风分枝杆菌生物学性状： 与结核菌相似，常呈束状排列，人工培养未成功。2020/11/369 麻风分枝杆菌生物学性状：2020/11/369Leprosy bacilliaci

34、d-fast stain2020/11/370Leprosy bacilli2020/11/370habitat and transmission habitat: human skin and superficial nerves transmission: by aerosol or prolonged contact with patients with lepromatous leprosy2020/11/371habitat and transmission habitClinical findingsIncubation period for several yearsOnset

35、gradual2020/11/372Clinical findingsIncubation pe传播方式呼吸道也可通过接触传染发病慢, 病程长麻风的免疫主要是靠细胞免疫细菌主要侵犯外周神经、皮肤二、致病性与免疫性：2020/11/373传播方式二、致病性与免疫性：2020/11/373pathogenesislesions: in the cooler parts of the bodyReplicate intracellularly, typically within skin histiocytes, endothelial cells and the Schwann cells of

36、nerves 2020/11/374pathogenesislesions: in the co2 types :Lepromatous、Tuberculoid 2 forms: Borderline 、indeterminate 2020/11/3752 types :Lepromatous、Tuberculo临床分为 两型(瘤型、结核样型) 两类(界线类、未定类)。2020/11/376临床分为2020/11/376lepromatous leprosy:瘤型麻风1. the cell-mediated response to Leprosy bacilli is poor 2. large numbers of organisms appear in the lesions and blood (bacteremia) (powerful infectious)3. involving the skin and mucous membranes 4. multiple nodular s