5章细菌感染的检查与防治课件

Chapter 51Diagnosis 2 Signs and symptoms vary according to Signs and symptoms vary according to the site and severity of infection.the site and severity of infection.Diagnosis requires a composite of Diagnosis requires a composite of information,including information,including history,physical history,physical examination,radiographic findings,and examination,radiographic findings,and laboratory data.laboratory data.Signs and symptoms vary 3laboratory AssaysMorphological assaysMorphological assaysLight or electron microscopyLight or electron microscopyIsolation and differentiationIsolation and differentiationSerological assaysSerological assaysAntigen-antibody assays Antigen-antibody assays Molecular assaysMolecular assaysMicroorganisms gene(DNA&RNA)Microorganisms gene(DNA&RNA)laboratory AssaysMorphological4 Diagnosis of Etiology:Diagnosis of Etiology:Golden standardGolden standard is to detect the is to detect the pathogenic bacterium pathogenic bacterium Diagnosis of Etiology:5 Specimen Collection and ProcessingnObtain specimens from the infected siteObtain specimens from the infected sitenAvoid contamination from the normal floraAvoid contamination from the normal floranTransporting and storing correctlyTransporting and storing correctlynBefore antimicrobial drugs are administered.Before antimicrobial drugs are administered.nProviding essential informationProviding essential information Specimen Collection and Proce65章细菌感染的检查与防治课件7 General procedure for collecting and processing specimens for aerobic and/or anaerobic bacterial culture General procedure for c85章细菌感染的检查与防治课件9 Direct assayu Morphological Assayu Element Assayu Toxin Assay Direct assay Morphological As10u Morphological AssaynNon-stained microscopic observationqDark-field microscopyqObserving the movement of live bacterianStained microscopic observationsqGram stainqAcid-fast stainqFluorescence stain Morphological AssayNon-staine115章细菌感染的检查与防治课件125章细菌感染的检查与防治课件135章细菌感染的检查与防治课件14u Element AssaynAntigen detectionnNucleic acid detectionnToxin detection Element AssayAntigen detectio15nAntigen detectionqCoagglutination testqPrecipitation testqELISAqFluoroimmunoassay,FIA qRadioimmunoassay,RIAAntigen detection16Coagglutination testCoagglutination test17Precipitation testPrecipitation test18Fluoroimmunoassay,FIAFluoroimmunoassay,FIA19nNucleic acid detectionqNucleotide hybridizationqPCRqGene chipNucleic acid detection205章细菌感染的检查与防治课件21PCRPCR225章细菌感染的检查与防治课件23Gene Chip/microarrayGene Chip/microarray24nToxin detectionqEndotoxin detection -Limulus testqExotoxin detection -Elek plate testqAnimal test -LD50,ID50Toxin detection25Limulus testLimulus test26Elek plate testElek plate test27 Culture&Identifyu Isolation&Cultureu Identify Morphological identify Biochemical reaction Serological assays Antibiotics susceptibility test Others Culture&Identify Isolation 28u Isolation&Culture:ColonynSizenShapenColornSurface featuresqSmooth-RoughnTransparencynHemolysis Isolation&Culture:ColonySi29u Biochemical Reactions Sugar Fermentation H2S Test Citrate utilization Biochemical Reactions Sugar305章细菌感染的检查与防治课件31 Diffusion Method Diffusion Method32u MIC&MBCnMinimum Inhibitory Concentration，MICnMinimum Bactericidal Concentration，MBCnBactericidal drugs usually have an MBC equal or very similar to the MICnBacteriostatic drugs usually have an MBC significantly higher than the MIC MIC&MBCMinimum Inhibitory C335章细菌感染的检查与防治课件34E testDiffusion method +Dilution methodE testDiffusion method 35 Serological Diagnosis Detection antibodies in the patients serum A current infection should be u IgM positiveIgM positiveuu A 4-fold or greater rise on antibody titer between the A 4-fold or greater rise on antibody titer between the acute serum sample and the convalescent serum sample acute serum sample and the convalescent serum sample Serological Diagnosis Detect36 Agglutination test Complement fixation test Neutralization test ELISAWestern blot analysisu Species Agglutination test Species37pp A single IgG antibody titer is difficult to interpret because A single IgG antibody titer is difficult to interpret because it is unclear whether it represents a current or a previous it is unclear whether it represents a current or a previous infection infectionpp the convalescent sample is usually taken 10-14 days the convalescent sample is usually taken 10-14 days afterafter the acute sample.By this time,the patient has often the acute sample.By this time,the patient has often recovered and the diagnosis becomes a retrospective recovered and the diagnosis becomes a retrospective oneoneuu Major disadvantage A single IgG antibody titer i38Prevention and Treatment of ba39PreventionArtificialimmunityInnateimmunityActive immunityPassive immunity Specific PreventionActive immunityPassive immunityPreventionArtificialInnateActi40PreventionPassiveimmunityActiveimmunityVaccinesAdjuvantsCytokine,LAK cellAntiserum,AntitoxinsToxoidsImmunoglobulinPreventionPassiveActiveVaccine41 Vaccines are antigens prepared from pathogens that can raise a protective immune response,yet do not cause illness.u Artificial active immunity Vaccines are antige42VaccinesInactivated vaccinesLive(attenuated)vaccinesSubunit vaccinesGene engineered vaccineDNA vaccinesToxoidVaccinesInactivated vaccinesL43较高，较高，维持维持3535年甚至更长年甚至更长较低，较低，维持数月维持数月22年年免疫效果免疫效果不易保存，不易保存，44数周数周易保存，约易保存，约1 1年年保存及有效期保存及有效期量较小，量较小，1 1次次量较大，量较大，2323次次接种剂量与特点接种剂量与特点活减毒株活减毒株死，强毒株死，强毒株制剂特点制剂特点活疫苗活疫苗死疫苗死疫苗区别点区别点Inactivated vaccine&Attenuat44nAntitoxin:e.g.Tetanus antitoxin and diphtheria antitoxin nAntiserumnSpecific immunoglobulinnCytokineu Artificial passive immunityAntitoxin:Artificial passive45ninvolves giving both a vaccine to provide long-term protection(preventive infection)and immune globulin to provide immediate protection(therapeutic and preventive infectious disease).u Active-passive immunityinvolves giving both a vaccine46Treat or emergency prevebtionPreventionMain usageshort，23WLong,several years several monthsDurationFastslow，24WTime of responseAntibody,cytokineAntigensubstancePassive immunityAvtive immunityitmsArtificial active and passive 47国家免疫规划疫苗国家免疫规划疫苗:20082008年年2 2月月 以前以前:乙肝疫苗、卡介苗、脊灰疫苗、百白破疫苗、麻乙肝疫苗、卡介苗、脊灰疫苗、百白破疫苗、麻 疹疫苗、白破疫苗疹疫苗、白破疫苗08:08:甲肝疫苗、流脑疫苗、乙脑疫苗、麻风腮疫苗甲肝疫苗、流脑疫苗、乙脑疫苗、麻风腮疫苗重点人群和地区：重点人群和地区：出血热疫苗、炭疽疫苗、钩体疫苗出血热疫苗、炭疽疫苗、钩体疫苗国家免疫规划疫苗:2008年2月48预防的传染病预防的传染病1515种种:乙肝、结核、脊灰、百日咳、白喉、破伤风、麻疹、乙肝、结核、脊灰、百日咳、白喉、破伤风、麻疹、甲肝、流脑、乙脑、风疹、腮腺炎、出血热、炭疽、钩甲肝、流脑、乙脑、风疹、腮腺炎、出血热、炭疽、钩体体预防的传染病15种:49 Antimicrobial chemotherapynChemotherapy as a science began with Paul Ehrlich in the first decade of the 20th century.nEhrlichs experiments led to the arsphenamines(胂凡纳明)for syphilis,the first planned chemotherapy.Antimicrobial chemotherapyCh505章细菌感染的检查与防治课件51金葡菌菌血症的死亡率 Rubin RJ et al.Emerging Infect Dis 1999;5:9-17青霉素时代耐青霉素时代苯唑西林时代万古霉素时代抗生素前时代%金葡菌菌血症的死亡率 Rubin RJ et al.Em52 近年来，世界抗生素市场的平均年增长率约为近年来，世界抗生素市场的平均年增长率约为8%8%，世界抗感染药物市场销售额为，世界抗感染药物市场销售额为400400亿美元，约占全亿美元，约占全球治疗性药物市场的球治疗性药物市场的10%10%。各类抗感染药具体销售情况是：各类抗感染药具体销售情况是：抗生素抗生素占世界抗占世界抗感染药物市场的最大份额感染药物市场的最大份额(约约250250亿亿260260亿美元亿美元)；抗抗病毒病毒药居第二位药居第二位(约约5555亿亿5656亿美元亿美元)；第三位为；第三位为抗真抗真菌菌药药(40(40亿亿4242亿美元亿美元)；其余则为疫苗和抗原生动物；其余则为疫苗和抗原生动物药等抗感染药小品种。药等抗感染药小品种。近年来，世界抗生素市场的平均年增长率约为8%53 头孢菌素头孢菌素类在世界抗感染药物市场中占较大比重，类在世界抗感染药物市场中占较大比重，目前其销售额约占抗感染药销售额的目前其销售额约占抗感染药销售额的40%40%，有的国家，有的国家高于这一数值。在美国市场，头孢菌素的销售额占高于这一数值。在美国市场，头孢菌素的销售额占抗感染药销售额的抗感染药销售额的45%45%。545章细菌感染的检查与防治课件55u Use principle of Antibioticp Appropriate drugsp Appropriate dosagep Alternate usep Drug combination Use principle of Antibiotic 56思考题思考题1 1、根据已学知识，如何对细菌性感染患者提出、根据已学知识，如何对细菌性感染患者提出 微生物学的诊断方案？微生物学的诊断方案？2 2、简述细菌感染的特异性预防措施。、简述细菌感染的特异性预防措施。预习：预习：消毒灭菌与生物安全消毒灭菌与生物安全思考题1、根据已学知识，如何对细菌性感染患者提出预习：消毒灭57