肠道感染病毒-微生物教学课件

MedicalMicrobiologyDepartmentofMicrobiology,

HMU第三篇医学相关病毒第31章肠道感染病毒Gastrointestine-InfectedViruses微生物学教研室钟照华教学大纲掌握内容肠道病毒种类及共同特性脊髓灰质炎病毒主要生物学性状、致病性、微生物学检查法及防治原则柯萨奇病毒分组、分型及致病性熟悉内容埃可病毒、肠道病毒70型、肠道病毒71型的致病性问题肠道病毒有哪些？是不是肠道感染的所有病毒都称为肠道病毒？简要说明肠道病毒的特性脊髓灰质炎病毒的传播途径、致病机制是什么？如何预防脊灰？B组柯萨奇病毒的致病有何特点？ECHO病毒、轮状病毒、杯状病毒、小圆结构病毒分别与哪些疾病有关？GroupsandSerotypesPicornaviridae（小RNA病毒科）Atleast71serotypes,dividedinto4subgroupsPolioviruses（脊髓灰质炎病毒）Coxsackieviruses（柯萨奇病毒）Echoviruses（埃可病毒）Newenteroviruses（新肠道病毒）morerecently,newenterovirusessubtypehavebeenallocatedsequentialnumbers(68-71))EnterovirusesSerotypesMorphology27nm,icosahedralsymmetry,noenvelopeEnterovirusstructureSurfacecleft–attachmenttocellularreceptors:Immunoglobulinsuperfamily,integrins,ICAM-1肠道病毒特点生物学性状小球形病毒（~30nm），无包膜核酸为+ssRNA，有感染性衣壳蛋白VP1-VP3分布在表面，VP4与RNA结合在胞浆增殖，有明显CPE，破胞释放耐酸耐乙醚，但鼻病毒除外引起多种疾病麻痹、无菌性脑膜炎、心肌损伤、腹泻、皮疹脊髓灰质炎病毒（Poliovirus）Firstidentifiedin1909byinoculationofspecimensintomonkeysFirstgrownincellculturein1949whichbecamethebasisforvaccinesTransmissionFecal–oralroute(粪－口途径)viahandsandobjects viafoodandwaterThefirstwrittenrecordofvirusinfectionAheiroglyphfromMemphis,drawninapproximately1400BC,whichdepictsatemplepriestcalledSiptahshowingtypicalclinicalsignsofparalyticpoliomyelitisFranklinD.RooseveltInthesummerof1921,whenhewas39,disasterhit-hewasstrickenwithpoliomyelitis.Demonstratingindomitablecourage,hefoughttoregaintheuseofhislegs,particularlythroughswimming.ManifestationsMostinfectionsasymptomatic,95%Abortivepolio(minorillness),5%fever,malaise,sorethroat,myalgia,headacheAsepticmeningitis(nonparalyticpolio),1%Paralyticpolio(majorillness),0.1%asymetricflaccidparalysis/paresis.Lower,orupperextremitiesPost-poliosyndromeprogressiveatrophyyearslater免疫性牢固特异免疫，体液免疫为主肠道局部sIgA血液中和性IgG、IgM抗体中和抗体可长时间维持（终生）3型间交叉保护极弱LaboratoryDiagnosisVirusIsolationSerology预防原则CurrentStatusofWildPoliovirusTransmission我国政府规定每年12月5日和1月5日为脊灰疫苗日。柯萨奇病毒（Coxsackievirus）1948年美国纽约州Coxsackie镇一名疑似脊髓灰质炎的患儿粪便中用乳鼠接种的方法分离发现GroupsGroupAviruses(23types)GroupBviruses(6types)DistinguishedfromotherenterovirusesbytheirpathogenicityforsucklingmiceGroupbasedonthelesionsinsucklingmice.PathogenesisFecal-OralroutetrasmissionSpreadinthebodylikepoliovirusesDiseaseAssociationsParalyticDiseaseMeningitisEncephalitisUndifferentiatedfebrileillnessHandfootmouthdiseaseHerpanginaEpidemicPleurodynia(Bornholmdisease)MyocarditisRespiratoryInfectionsRubelliformrashesNeonatalInfectionConjunctivitisPancreatitis/DiabetesExanthems-RubelliformrashesEVleadingcauseinsummer&fall.AlltypesofrashHand-foot-and-mouthdiseaseHand-foot-and-mouthdisease:mostlycoxackieAfever,malaise,sorethroat,vesiclesonbucalmucosa,tongue,hands,feet,buttockshighlyinfectiousresolution–1wHerpanginaHerpangina–usuallycoxackieAacuteonset,fever,sorethroat,dysphagialesions–posteriorpharynxcanpersistw’snogingivitisLaboratoryDiagnosisVirusIsolationSerologyManagementandPreventionThereisnospecificantiviraltherapyavailableagainstenterovirusesotherthanpolio.IVIGHNIGThereisnovaccineEchovirusesThefirstechoviruseswereaccidentallydiscoveredin1951duringepidemiologicalstudiesofpolioviruses.CPEincellculturesTypesThereare32echoviruses

NogroupAgPathogenesis主要导致无菌性脑炎、类脊髓灰质炎等感染后对同型病毒可产生持久免疫诊断困难尚无疫苗预防以隔离为主NewEnteroviruses4newenteroviruses(68-72)Enterovirus71appearstobehighlypathogenicandhasbeenassociatedwithepidemicsofavarietyofacutediseasesEnterovirus72wasassignedtoanewfamilycalledheptovirusesDiseasesassociatedwithEnterovirusesVirusesCausedAcuteGastroenteritisRotavirusHumanCalicivir