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1、关于临床病原学检查1第1页，讲稿共30张，创作于星期一2病例分析病例分析 以以性传播性疾病性传播性疾病性传播性疾病性传播性疾病为例为例 n n【病史摘要】n n （一）入院病历n n 患者：陈某，男性，25岁，音响推销员，未婚。1998年3月8日入院。住院号32334。n n 主诉：龟头部长“疱疮”，反复不愈。第2页，讲稿共30张，创作于星期一3n n 现现病病史史：阴阴茎茎、包包皮皮两两侧侧、龟龟头头部部出出现现小小水水疱疱，疼疼痛痛难难忍忍。患患者者2 2年年前前曾曾与与一一酒酒店店服服务务员员热热恋恋，有有过过性性接接触触。此此后后约约10天天左左右右，龟龟头头部部感感到到灼灼热热，不不
2、久久即即感感疼疼痛痛，并并出出现现几几个个小小水水疱疱。很很快快破破溃溃渗渗水水。经经某某医医院院诊诊治治，按按“性性病病”治治疗疗，注注射射“利利福福平平”、“淋淋必必治治”等等药药物物，未未见见好好转转，反反而而创创面面扩扩大大，水水疱疱溃溃破破相相连连成成片片，20余余天天后后相相继继消消退退。约约1 12 2月后，外生殖器又出现小水疱，症状比前更为严重，故来院就诊。n n 既往史：身体健康，无其他系统疾患。既往史：身体健康，无其他系统疾患。n n 个人家庭史：无不良生活史，父母健在。个人家庭史：无不良生活史，父母健在。第3页，讲稿共30张，创作于星期一4n n体体体体格格格格检检检检查
3、查查查：神神志志清清，全全身身倦倦怠怠。体体温温37.6，脉脉搏搏7272次次/分分，呼呼吸吸2121次/分分，血血压压110/70mmHg110/70mmHg。心心肺肺检检查查无无异异常常发发现现，腹腹 ，肝肝脾脾未未及及，无无肾肾区区叩叩击击痛痛。外外生生殖殖器器皮皮肤肤见见阴阴茎茎、龟龟头头部部有有豌豌豆豆、米米粒粒、大大头头针针大大小小不不一一的的小小水水疱疱，部部分分水水疱疱融融合合，破破溃溃，中中央央伴伴糜糜烂烂，微微痛痛。腹腹股股沟沟淋淋巴巴结结稍稍肿肿大大，压压痛痛明明显显，排排尿尿不不适适，下肢疼痛。下肢疼痛。n n辅助检查：辅助检查：辅助检查：辅助检查：旧结核菌素试验弱阳性
4、，肾旧结核菌素试验弱阳性，肾B B超检查未见超检查未见异常，尿液一般检查异常，尿液一般检查WBC（+）、）、RBCRBC（），蛋），蛋白（白（-）疱疹分泌液涂片、革兰染色、镜检，未见革兰）疱疹分泌液涂片、革兰染色、镜检，未见革兰阴性双球菌。阴性双球菌。第4页，讲稿共30张，创作于星期一5n n 入入院院初初步步诊诊断断：性传播性疾病，（Sexually transmitted diseases,STDs）可疑生殖器疱疹（再发型）。第5页，讲稿共30张，创作于星期一6临床病原体检查目的:n n临床病原体检查目的:是确定感染的发生和性质，在疾病早期提供恰当的治疗方案，并采取有效的预防措施，防止感染
5、传播造成的危害。第6页，讲稿共30张，创作于星期一7各种不同病原体的实验诊断方法各种不同病原体的实验诊断方法遵循以下基本原则：遵循以下基本原则：1.1.正确、规范采集和运送标本。正确、规范采集和运送标本。2.2.直接显微镜查见病原体或检出病直接显微镜查见病原体或检出病原体抗原，借助分子生物学的方原体抗原，借助分子生物学的方法检测病原体核酸，结合病人的法检测病原体核酸，结合病人的病史、症状或体征，快速作出初病史、症状或体征，快速作出初步诊断。步诊断。第7页，讲稿共30张，创作于星期一8各种不同病原体的实验诊断方法各种不同病原体的实验诊断方法遵循以下基本原则：遵循以下基本原则：3.初步诊断同时，对
6、病原体进行分离与鉴定。4.4.检测机体对病原体的免疫产物。检测机体对病原体的免疫产物。5.5.参与临床选择抗菌药物，指导参与临床选择抗菌药物，指导 和监控微生物的治疗方案，避免和监控微生物的治疗方案，避免 耐药菌株的产生。耐药菌株的产生。第8页，讲稿共30张，创作于星期一9姬姆萨染色衣原体包涵体HSV病毒被支原体感染的精子梅毒螺旋体第9页，讲稿共30张，创作于星期一10检测项目显微镜检查n n阴道、尿道分泌物阴道、尿道分泌物n n下疳、湿疣、脓疱疹液下疳、湿疣、脓疱疹液n n疱疹基底组织刮片疱疹基底组织刮片n n宫颈拭子或刮片宫颈拭子或刮片第10页，讲稿共30张，创作于星期一11检测项目分离、
7、培养、鉴定标本接种：选择合适的培养基、观察菌落性状作生化鉴定n n病毒、立克次体、衣原体、接种细胞或易感动物观察增殖指标和血清学方法鉴定。第11页，讲稿共30张，创作于星期一12检测项目分离、培养、鉴定A、在培养基上1/4的表面滚动棉拭接种B、装淋球菌培养皿的合适罐子第12页，讲稿共30张，创作于星期一13检测项目分离、培养、鉴定C、巧克力琼脂上淋病奈瑟菌菌落D、几种奈瑟菌的快碳水化合物降解试验第13页，讲稿共30张，创作于星期一14检测项目抗体检测 梅毒血清学试验n n非密螺旋体抗原试验：（venereal disease reearch venereal disease reearch l
8、aboratorylaboratory，VDRLVDRL）不加热血清反应素玻片试不加热血清反应素玻片试验（验（USRUSR）快速血浆反应素环状卡片快速血浆反应素环状卡片试验（试验（RPRRPR）自动反应素试验（自动反应素试验（ARTART）第14页，讲稿共30张，创作于星期一15检测项目抗原检测n n1、单纯疱疹病毒抗原检测n n2、HIV抗原检测n n3、衣原体抗原检测HIV抗原检测实验原理示意图第15页，讲稿共30张，创作于星期一16检测项目核酸检测n n1 1、HIVHIV核酸检测核酸检测n n2 2、梅毒螺旋体、梅毒螺旋体PCRPCR检测检测n n3、衣原体核酸探针、衣原体核酸探针n
9、n4 4、支原体核酸检测第16页，讲稿共30张，创作于星期一17细菌感染检查检验特点n n通过对标本直接显微镜检，病原菌的分离培养鉴定，病原菌的抗原检测，核酸检测和细菌感染后机体免疫应答产物的测定及药物的测定及药物敏感性试验，对细菌感染性疾病可作出及时、准确的病原学诊断。第17页，讲稿共30张，创作于星期一18 检测程序第18页，讲稿共30张，创作于星期一19Diagnosis of bacterial infections n nThe The identification identification and and differentiation differentiation of o
10、f bacteria bacteria principally relies:principally relies:n n -on microbial morphology and growth variables on culturing the organisms on non-selective and selective media.Culture remains the standard for diagnosis of bacterial infection because it is the simplest,the most reliable and the most cost
11、 efficient method.Another advantage is the fact that parallel testing of the sensitivity towards antibiotics is possible.第19页，讲稿共30张，创作于星期一20n nn molecular-biological technics that provide rapid identification of infectious agents,both from culture isolates and directly within clinical specimens.n n
12、 -on the detection of the antibody response to the pathogen.The concentration of infection-sepcific antibodies is determined in titers or activity units.第20页，讲稿共30张，创作于星期一21n nIn principle,the pathogen should be identified by culture in any acute infection that requires treatment.This,however,is onl
13、y possible if the pathogen is still detectable in excretions,secretions,blood or tissue at the time when the clinical symptoms occur,e.g.salmonellae in feces in the case of diarrhea or gonococci from endocervical canal in genital tract infection.第21页，讲稿共30张，创作于星期一22病毒感染检查检验特点n n标本处理：必须经滤过除菌，标本需迅速冷藏、
14、运送。n n病毒分离培养后，根据细胞病变特征确定病毒的种，对已分离的病毒用已知参考血清作中和试验、补体结合试验、血凝抑制试验。n n新的早期诊断技术：核酸杂交技术、PCR技术。第22页，讲稿共30张，创作于星期一23病实毒验感室染诊性断疾 病 的 第23页，讲稿共30张，创作于星期一24Diagnosis of viral infectionsn n The primary diagnostic technique for most viral infections is the isolation of the virus in cell culture.Serologic techniqu
15、es may also be useful,especially if the virus was isolated from a nonsterile site.In some instances,serologic diagnoses is the only practical approach in a clinical laboratory.Direct detection of antigen in body fluids or tissues has also been effective for some viruses.The list of agents for which
16、direct detection of antigen is useful will undoubtedly continue to expand.第24页，讲稿共30张，创作于星期一25n n The compare of the advantages and disadvantages of each of these approaches:n nCultureCulture:TimeTime:Days to weeks:Days to weeks AdvantagesAdvantages:Specificity and sensitivity maximum;isolate:Specif
17、icity and sensitivity maximum;isolate available for characterizationavailable for characterization DisadvantagesDisadvantages:Cell culture facilities needed;time for:Cell culture facilities needed;time for diagnosis may be longdiagnosis may be long第25页，讲稿共30张，创作于星期一26n nDirect detectionDirect detect
18、ion:TimeTime:Hours to 1 day:Hours to 1 day AdvantagesAdvantages:Speed of diagnosis;used for viruses:Speed of diagnosis;used for viruses difficult to culturedifficult to culture Disadvantages Disadvantages:False-positives and negatives;hard:False-positives and negatives;hard to batch teststo batch te
19、stsn nSerology:TimeTime:Weeks:Weeks AdvantagesAdvantages:Assessment of immunity or response:Assessment of immunity or response to virus isolated from nonsterile site;used for viruses to virus isolated from nonsterile site;used for viruses difficult to culturedifficult to culture DisadvantagesDisadva
20、ntages:Potential cross-reaction;need for acute:Potential cross-reaction;need for acute and convalescent specimensand convalescent specimens第26页，讲稿共30张，创作于星期一27真菌感染检查检验特点n n形态学检查为检测真菌的重要手段n n抗原检测适合血清和脑脊液中隐球菌、念珠菌、夹膜组织胞浆菌。n n血清学诊断适用于深部真菌感染。第27页，讲稿共30张，创作于星期一28Direct Examinationn n It is highly recommen
21、ded that a direct microscopic It is highly recommended that a direct microscopic examination be made on most this provide an immediate examination be made on most this provide an immediate presumptive diagnosis for the physician,but it may also aid in presumptive diagnosis for the physician,but it m
22、ay also aid in the selection of an appropriate culture medium.the selection of an appropriate culture medium.n n A phase-contrast microscope is a valuable adjunct in the A phase-contrast microscope is a valuable adjunct in the direct examination of specimens.The advantages include the direct examina
23、tion of specimens.The advantages include the following:1)mounts can be made and examined following:1)mounts can be made and examined quickly;2)there is no need for direct staining;and3)the objects quickly;2)there is no need for direct staining;and3)the objects can be clearly visualized.can be clearly visualized.第28页，讲稿共30张，创作于星期一29n n菌丝、孢子第29页，讲稿共30张，创作于星期一07.04.2023感感谢谢大大家家观观看看第30页，讲稿共30张，创作于星期一