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1、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 钟照华第1页/共48页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 第2页/共48页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？第3页/共48页G
2、roups and SerotypesPicornaviridae（小RNA病毒科）At least 71 serotypes,divided into 4 subgroupsPolioviruses（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)第4页/共48页Enteroviruses Serotypes第5页/共48页Mo
3、rphology27nm,icosahedral symmetry,no envelope第6页/共48页Enterovirus structureSurface cleft attachment to cellular receptors:Immunoglobulin superfamily,integrins,ICAM-1第7页/共48页第8页/共48页第9页/共48页第10页/共48页第11页/共48页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
4、除外引起多种疾病麻痹、无菌性脑膜炎、心肌损伤、腹泻、皮疹第12页/共48页脊髓灰质炎病毒（Poliovirus）First identified in 1909 by inoculation of specimens into monkeysFirst grown in cell culture in 1949 which became the basis for vaccines第13页/共48页TransmissionFecal oral route(粪口途径)via hands and objectsvia food and water第14页/共48页第15页/共48页第16页/共48
5、页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第17页/共48页Franklin D.RooseveltIn the summer of 1921,when he was 39,disaster hit-he was stricken wit
6、h poliomyelitis.Demonstrating indomitable courage,he fought to regain the use of his legs,particularly through swimming.第18页/共48页ManifestationsMost infections asymptomatic,95%Abortive polio(minor illness),5%fever,malaise,sore throat,myalgia,headacheAseptic meningitis(non paralytic polio),1%Paralytic
7、 polio(major illness),0.1%asymetric flaccid paralysis/paresis.Lower,or upper extremitiesPost-polio syndromeprogressive atrophy years later第19页/共48页第20页/共48页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型间交叉保护极弱第21页/共48页Laboratory DiagnosisVirus IsolationSerology第22页/共48页预防原则流行期不宜做小儿扁挑体摘除术和其他疫
8、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第23页/共48页Current Status of Wild Poliovirus Transmission第24页/共48页我国政府规定每年12月5日和1月5日为脊灰疫苗日。第25页/共48页柯萨奇病毒（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第26页/共48页GroupsGroup A viruses(23 types)Group B viruses(6 types)Distinguished from other enteroviruses by t
9、heir pathogenicity for suckling miceGroup based on the lesions in suckling mice.第27页/共48页PathogenesisFecal-Oral route trasmissionSpread in the body like polioviruses第28页/共48页第29页/共48页第30页/共48页第31页/共48页Disease AssociationsParalytic DiseaseMeningitis Encephalitis Undifferentiated febrile illness Hand
10、foot mouth diseaseHerpanginaEpidemic Pleurodynia(Bornholm disease)第32页/共48页Myocarditis Respiratory Infections Rubelliform rashes Neonatal Infection Conjunctivitis Pancreatitis/Diabetes第33页/共48页Exanthems-Rubelliform rashes EV leading cause in summer&fall.All types of rash第34页/共48页Hand-foot-and-mouth
11、diseaseHand-foot-and-mouth disease:mostly coxackie Afever,malaise,sore throat,vesicles on bucal mucosa,tongue,hands,feet,buttockshighly infectiousresolution 1w第35页/共48页HerpanginaHerpangina usually coxackie Aacute onset,fever,sore throat,dysphagia lesions posterior pharynxcan persist wsno gingivitis第
12、36页/共48页Laboratory DiagnosisVirus IsolationSerology第37页/共48页Management and PreventionThere is no specific antiviral therapy available against enteroviruses other than polio.IVIG HNIGThere is no vaccine第38页/共48页EchovirusesThe first echoviruses were accidentally discovered in 1951 during epidemiologic
13、al studies of polioviruses.CPE in cell cultures第39页/共48页TypesThere are 32 echoviruses No group Ag第40页/共48页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第41页/共48页New Enteroviruses4 new enteroviruses(68-72)Enterovirus 71 appears to be highly pathogenic and has been associated with epidemi
14、cs of a variety of acute diseasesEnterovirus 72 was assigned to a new family called heptoviruses第42页/共48页Diseases associated with Enteroviruses第43页/共48页Viruses Caused Acute GastroenteritisRotavirusHuman Calicivirus,HuCVSmall Round Structure Virus,SRSVAstrovirusEnteric Adenvirus,EAdV第44页/共48页Rotaviruses第45页/共48页Small Round Structure Virus第46页/共48页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型的致病性第47页/共48页感谢您的观看。第48页/共48页