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Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Department of Microbiology,Harbin Medical University,Medical Microbiology,Department of Microbiology,HMU,第三篇 医学相关病毒,第31章 肠道感染病毒,Gastrointestine-Infected Viruses,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？,Groups and Serotypes,Picornaviridae（小RNA病毒科）,At least 71 serotypes,divided into 4 subgroups,Polioviruses（脊髓灰质炎病毒）,Coxsackie viruses（柯萨奇病毒）,Echoviruses（埃可病毒）,New enteroviruses（新肠道病毒）,more recently,new enteroviruses subtype have been allocated sequential numbers(68-71),Enteroviruses Serotypes,Morphology,27nm,icosahedral symmetry,no envelope,Enterovirus structure,Surface cleft attachment to cellular receptors:,Immunoglobulin superfamily,integrins,ICAM-1,肠道病毒特点,生物学性状,小球形病毒（30 nm），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）,First identified in,1909,by inoculation of specimens into monkeys,First grown in cell culture in,1949,which became the basis for vaccines,Transmission,Fecal oral route(粪口途径),via hands and objects,via food and water,The first written record,of virus infection,A heiroglyph from Memphis,drawn in approximately 1400BC,which depicts a temple priest called Siptah showing typical clinical signs of paralytic poliomyelitis,Franklin D.Roosevelt,In the summer of 1921,when he was 39,disaster hit-he was stricken with poliomyelitis.Demonstrating indomitable courage,he fought to regain the use of his legs,particularly through swimming.,Manifestations,Most infections asymptomatic,95%,Abortive polio(minor illness),5%,fever,malaise,sore throat,myalgia,headache,Aseptic meningitis(non paralytic polio),1%,Paralytic polio(major illness),0.1%,asymetric flaccid paralysis/paresis.Lower,or upper extremities,Post-polio syndrome,progressive atrophy years later,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,Laboratory Diagnosis,Virus Isolation,Serology,预防原则,流行期不宜做小儿扁挑体摘除术和其他疫苗接种,疫苗接种：最好的手段,被动免疫：易感者用丙种球蛋白,Current Status of Wild Poliovirus Transmission,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,Groups,Group A viruses(23 types),Group B viruses(6 types),Distinguished from other enteroviruses by their pathogenicity for suckling mice,Group based on the lesions in suckling mice.,Pathogenesis,Fecal-Oral route trasmission,Spread in the body like polioviruses,Disease Associations,Paralytic Disease,Meningitis,Encephalitis,Undifferentiated febrile illness,Hand foot mouth disease,Herpangina,Epidemic Pleurodynia(Bornholm disease),Myocarditis,Respiratory Infections,Rubelliform rashes,Neonatal Infection,Conjunctivitis,Pancreatitis/Diabetes,Exanthems-Rubelliform rashes,EV leading cause in summer&fall.All types of rash,Hand-foot-and-mouth disease,Hand-foot-and-mouth disease:mostly coxackie A,fever,malaise,sore throat,vesicles on bucal mucosa,tongue,hands,feet,buttocks,highly infectious,resolution 1w,Herpangina,Herpangina usually coxackie A,acute onset,fever,sore throat,dysphagia,lesions posterior pharynx,can persist ws,no gingivitis,Laboratory Diagnosis,Virus Isolation,Serology,Management and Prevention,There is no specific antiviral therapy available against enteroviruses other than polio.,IVIG,HNIG,There is no vaccine,Echoviruses,The first echoviruses were accidentally discovered in 1951 during epidemiological studies of polioviruses.,CPE in cell cultures,Types,There are,32 echoviruses,No group Ag,Pathogenesis,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,New Enteroviruses,4 new enteroviruses(68-72),Enterovirus 71,appears to be highly pathogenic and has been associated with epidemics of a variety of acute diseases,Enterovirus 72,was assigned to a new family called heptoviruses,Diseases associated with Enteroviruses,Viruses Caused Acute Gastroenteritis,Rotavirus,Human Calicivirus,HuCV,Small Round Structure Virus,SRSV,Astrovirus,Enteric Adenvirus,EAdV,Rotaviruses,Small Round Structure Virus,小结,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,埃可病毒、肠道病毒70型、肠道病毒71型的致病性,
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