肺炎链球菌课件

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

1.Chapter8球菌（coccus）pyogenic葡萄球菌属（staphylococci）MorphologyTypicalOrganismsGrampositivespherical

cells革兰阳性球菌grape-likeclusters葡萄串状2.葡萄球菌属（staphylococci）MorphologyculturegrowreadilyonmostmediaOrdinaryplate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)3.culturegrowreadilyonmostmeBiochemistryreaction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

4.Biochemistryreaction触酶阳性4.

Antigenicstructure抗原构造capsulepolysaccharide(teichoicacid)SPA5.Antigenicstructure抗原构造capsulSPA（staphylococcalproteinA）

ProteinAisasurfaceproteinofSaureuswhichbindsIgG1,IgG2,andIgG4moleculesbytheirFcregion.

FabFc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。6.SPA（staphylococcalproteinA）

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)7.classificaion色素、生化反应7.

金黄色葡萄球菌表皮葡萄球菌腐生葡萄球菌pigment色素金黄色白色白色或柠檬色fermentmannitol发酵甘露醇+--coagulase凝固酶+--αhemolysins溶素+--thermostabledeoxyribonuclease耐热核酸酶+--SPA+--Pathogenicity致病性+-（致病性葡萄球菌的鉴别）8.

金黄色表皮腐生pigment色素金黄色白色白色或柠檬色feResistance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MRSA9.Resistance抵抗力

TheirresistancePathogenesis&Immunity

VirulenceFactors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10.Pathogenesis&Immunity

Virulecoagulase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11.coagulase凝固酶概念11.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）12.表皮剥脱毒素（exfoliativetoxin）引起机体发肠毒素（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13.肠毒素（enterotoxin）约1/3临床分离金黄色葡萄球

Clinicalfindings

：

Invasive侵袭性disease(suppurativeinflammation化脓性炎症)Localinfection局部感染boil疖，carbuncle痈，bronchitis支气管炎，pneumonia，meningitisSystematicinfections全身感染Septicemia败血症,pyemia脓毒血症

Toxinosis毒素性疾病Foodpoisoning食物中毒Staphylococcalscaldedskinsyndrome(SSSS)烫伤样皮肤综合征Toxicshocksyndrome毒性休克综合征Pseudomembranouscolitis假膜性肠炎14.

Clinicalfindings：Coagulase-negativeStaphylococcusspecies

凝固酶阴性葡萄球菌CNSUrinarytractinfection泌尿系统感染septicemiaopportunisticinfections15.Coagulase-negativeStaphylococImmunity

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16.Immunity

人类有一定的天然免疫力16.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17.ELISADiagnosticLaboratoryTesPrevention&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18.Prevention&Treatment防治防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）19.Streptococci链球菌属GrampositiveCulture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20.Culture培养特性：growthrequiresbl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）21.生化反应分解葡萄糖21.Ⅰ.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22.Ⅰ.Antigenicstructure抗原构造多糖抗原（Ⅱ.Hemolysisonbloodagar根据溶血现象分类apartialor"green"hemolysis草绿色溶血-Hemolysis-hemolyticstreptococcus甲型溶血性链球菌Opportunisticpathogencompletelysis完全溶血

-hemolysis-hemolyticstreptococcus乙型溶血性链球菌pathogenNonhemolytic不溶血γ-hemolysisγ-streptococcus丙型链球菌Non-pathogen23.Ⅱ.Hemolysisonbloodagar根据溶血现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、S24.Pathogenesis致病性GroupAStrepF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25.F蛋白（proteinF）ItmediatesadheHyaluronidase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）26.Hyaluronidase透明质酸酶spreadingfa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27.链球菌溶素（streptolysin）SLO：27.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28.致热外毒素（pyrogenicexotoxin，SPE）EClinicalfindings所致疾病：GroupAStreptococcus

A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29.Clinicalfindings所致疾病：GroupVirulencefactors致病物质：

S.pneumoniaecapsule荚膜Pathology所致疾病：Lobarpneumonia

大叶性肺炎30.VirulencefactorsS.pneumoniaSreptococcusviridans草绿色链球菌（α-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)31.Sreptococcusviridans草绿色链球菌suimmunity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32.immunity免疫性可刺激机体产生各种抗体肺炎链球菌32.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33.DiagnosticLaboratoryTests微生物血清学检查抗链球菌溶素O试验：抗O试验（ASOtest）34.血清学检查抗链球菌溶素O试验：抗O试验（ASOtest）3Prevention&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35.Prevention&Treatment35.Neisseria奈瑟菌属Gramnegative，aerobic

diplococci革兰阴性需氧双球菌N.gonorrhoeaeandN.meningitidis淋病奈瑟菌和脑膜炎奈瑟菌36.Neisseria奈瑟菌属GramnegativeN.meningitidis（meningococcus)

脑膜炎奈瑟菌kidney-shaped肾形37.N.meningitidis（meningococcus)Culture

aerobicbacteria专性需氧菌5～8％CO2enrichedmedia：heatedbloodagar(“chocolate”agar)

巧克力（色）培养基autolysin

38.Cultureaerobicbacteria专性需氧菌3AntigenicStructure抗原构造groupedonthebasisoftheircapsularpolysaccharides荚膜多糖群特异性抗原分群ThemostimportantserogroupsassociatedwithdiseaseinhumanareA,B,C,Y,andw-135Resistance抵抗力veryweak很弱四怕热寒冷干燥消毒剂39.AntigenicStructure抗原构造groupedPathogenesis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40.Pathogenesis致病性PathogenicsubImmunity：antibodiesintheserum血清中的抗体41.Immunity：antibodiesintheserDiagnosticLaboratoryTests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SPAcoagglutination

SPA协同凝集试验42.DiagnosticLaboratoryTests微生物

Prevention&Treatment防治原则children

capsularpolysaccharidevaccines

荚膜多糖疫苗

Treatment

Penicillin43.Prevention&Treatment防治原则cN.gonorrhoeae(gonococcus)淋病奈瑟菌Bean－shaped，usuallyseeninpairswithadjacentflattenedsides.平面相对，成对排列44.N.gonorrhoeae(gonococcus)淋pili菌毛outermembranousprotein外膜蛋白（PI,PII,PIII)LOSIgA1proteinase

IgA1蛋白酶gonorrhea淋病Humansaretheonlynaturalhost.Transmissionisviasexualcontact人类是淋病奈瑟菌的唯一宿主。主要通过性接触引起泌尿道和生殖系统炎症gonococcalophthalmianeonatorum新生儿淋菌性结膜炎throughbirthcanal通过产道感染致病物质Pathogenesis所致疾病45.pili菌毛gonorrhea淋病HumansarethRepeatedgonococcalinfectionsarecommon.Immunity46.RepeatedgonococcalinfectionsDiagnosticLaboratoryTests微生物学检查Specimens标本culture培养pusandsecretionsaretakenfromtheurethra,cervix尿道、宫颈等的脓汁和分泌物保暖、保湿、立即送检，培养基预温Smears直接涂片镜检typicalneisseriaewithinpolymorphonuclearleukocytes中性粒细胞内有革兰阴性双球菌heatedbloodagar(“chocolate”agar)巧克力（色）培养基47.DiagnosticLaboratoryTests微生物防治原则防开展防治性病的知识教育防止不正当的两性关系治抗生素

1%silvernitrateintheeyesofnewbornbabies新生儿1%硝酸银滴眼。48.防治原则防开展防治性病的知识教育防止不正当的两性关系治抗生素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

49.Chapter8球菌（coccus）pyogenic葡萄球菌属（staphylococci）MorphologyTypicalOrganismsGrampositivespherical

cells革兰阳性球菌grape-likeclusters葡萄串状50.葡萄球菌属（staphylococci）MorphologyculturegrowreadilyonmostmediaOrdinaryplate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)51.culturegrowreadilyonmostmeBiochemistryreaction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

52.Biochemistryreaction触酶阳性4.

Antigenicstructure抗原构造capsulepolysaccharide(teichoicacid)SPA53.Antigenicstructure抗原构造capsulSPA（staphylococcalproteinA）

ProteinAisasurfaceproteinofSaureuswhichbindsIgG1,IgG2,andIgG4moleculesbytheirFcregion.

FabFc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。54.SPA（staphylococcalproteinA）

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)55.classificaion色素、生化反应7.

金黄色葡萄球菌表皮葡萄球菌腐生葡萄球菌pigment色素金黄色白色白色或柠檬色fermentmannitol发酵甘露醇+--coagulase凝固酶+--αhemolysins溶素+--thermostabledeoxyribonuclease耐热核酸酶+--SPA+--Pathogenicity致病性+-（致病性葡萄球菌的鉴别）56.

金黄色表皮腐生pigment色素金黄色白色白色或柠檬色feResistance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MRSA57.Resistance抵抗力

TheirresistancePathogenesis&Immunity

VirulenceFactors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58.Pathogenesis&Immunity

Virulecoagulase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59.coagulase凝固酶概念11.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）60.表皮剥脱毒素（exfoliativetoxin）引起机体发肠毒素（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61.肠毒素（enterotoxin）约1/3临床分离金黄色葡萄球

Clinicalfindings

：

Invasive侵袭性disease(suppurativeinflammation化脓性炎症)Localinfection局部感染boil疖，carbuncle痈，bronchitis支气管炎，pneumonia，meningitisSystematicinfections全身感染Septicemia败血症,pyemia脓毒血症

Toxinosis毒素性疾病Foodpoisoning食物中毒Staphylococcalscaldedskinsyndrome(SSSS)烫伤样皮肤综合征Toxicshocksyndrome毒性休克综合征Pseudomembranouscolitis假膜性肠炎62.

Clinicalfindings：Coagulase-negativeStaphylococcusspecies

凝固酶阴性葡萄球菌CNSUrinarytractinfection泌尿系统感染septicemiaopportunisticinfections63.Coagulase-negativeStaphylococImmunity

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64.Immunity

人类有一定的天然免疫力16.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65.ELISADiagnosticLaboratoryTesPrevention&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66.Prevention&Treatment防治防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）67.Streptococci链球菌属GrampositiveCulture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68.Culture培养特性：growthrequiresbl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）69.生化反应分解葡萄糖21.Ⅰ.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70.Ⅰ.Antigenicstructure抗原构造多糖抗原（Ⅱ.Hemolysisonbloodagar根据溶血现象分类apartialor"green"hemolysis草绿色溶血-Hemolysis-hemolyticstreptococcus甲型溶血性链球菌Opportunisticpathogencompletelysis完全溶血

-hemolysis-hemolyticstreptococcus乙型溶血性链球菌pathogenNonhemolytic不溶血γ-hemolysisγ-streptococcus丙型链球菌Non-pathogen71.Ⅱ.Hemolysisonbloodagar根据溶血现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、S72.Pathogenesis致病性GroupAStrepF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73.F蛋白（proteinF）ItmediatesadheHyaluronidase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）74.Hyaluronidase透明质酸酶spreadingfa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75.链球菌溶素（streptolysin）SLO：27.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76.致热外毒素（pyrogenicexotoxin，SPE）EClinicalfindings所致疾病：GroupAStreptococcus

A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77.Clinicalfindings所致疾病：GroupVirulencefactors致病物质：

S.pneumoniaecapsule荚膜Pathology所致疾病：Lobarpneumonia

大叶性肺炎78.VirulencefactorsS.pneumoniaSreptococcusviridans草绿色链球菌（α-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)79.Sreptococcusviridans草绿色链球菌suimmunity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80.immunity免疫性可刺激机体产生各种抗体肺炎链球菌32.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81.DiagnosticLaboratoryTests微生物血清学检查抗链球菌溶素O试验：抗O试验（ASOtest）82.血清学检查抗链球菌溶素O试验：抗O试验（ASOtest）3Prevention&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83.Prevention&Treatment35.Neisseria奈瑟菌属Gramnegative，aerobic

diplococci革兰阴性需氧双球菌N.gonorrhoeaeandN.meningitidis淋病奈瑟菌和脑膜炎奈瑟菌84.Neisseria奈瑟菌属GramnegativeN.meningitidis（meningococcus)

脑膜炎奈瑟菌kidney-shaped肾形85.N.meningitidis（meningococcus)Culture

aerobicbacteria专性需氧菌5～8％CO2enrichedmedia：heatedbloodagar(“chocolate”agar)

巧克力（色）培养基autolysin

86.Cultureaerobicbacteria专性需氧菌3AntigenicStructure抗原构造groupedonthebasisoftheircapsularpolysaccharides荚膜多糖群特异性抗原分群ThemostimportantserogroupsassociatedwithdiseaseinhumanareA,B,C,Y,andw-135Resistance抵抗力veryweak很弱四怕热寒冷干燥消毒剂87.AntigenicStructure抗原构造groupedPathogenesis致病性Pathogenicsubstances