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1、Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University第二篇 致病性细菌第12章链球菌属Streptococcus 微生物学教研室 张文莉Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University链球菌的分类n分类方法有三种u根据溶血现象分类甲型溶血性链球菌乙型溶血性链球菌丙型溶血性链球菌u根据
2、多糖抗原分类 A-H,K-V20个族对人有致病性A族A族又称化脓性链球菌u根据对氧的需要分类Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical UniversityA族链球菌Streptococcus Group ADepartment of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University形态与染色n直径约1m，球形n革兰阳性n
3、链状排列n无鞭毛，不形成芽胞nA族有M蛋白以及脂磷壁酸形成的类菌毛结构n可形成透明质酸荚膜Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University 培养特性、生化反应n营养要求较高u血液或组织液、生长因子u菌落细小S型u溶血环u液体培养成絮状沉淀n生化反应u分解单糖产酸u不分解菊糖，不被胆汁溶解Department of Microbiology,Harbin Medical UniversityDepartment of Microbiolo
4、gy,Harbin Medical University抗原构造n核蛋白抗原（P抗原）u无特异性，各种链球菌均相同n多糖抗原（C抗原）u分群的依据n蛋白质抗原（表面抗原）u细胞壁蛋白。A族有M、T、R和S四种抗原，与致病性有关的是M抗原Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical UniversityDepartment of Microbiology
5、,Harbin Medical University细胞壁成分n脂磷壁酸（LTA）u人类多种细胞膜上有受体，与之结合，增强对宿主细胞的粘附性nM蛋白u心肌共同抗原u风湿热u急性肾小球肾炎Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical UniversityThe M ProteinDepartment of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medi
6、cal University致热外毒素n红疹毒素，猩红热毒素u基因：温和噬菌体u蛋白质u改变血脑屏障通透性，直接作用于下丘脑u引起发热和皮疹Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University链球菌溶血素(streptolysin)n溶血素O（SLO）u白细胞、血小板、心肌u抗“O”抗体ASOuASO可中和SLO活性，是实验室定量检测ASO基础n溶血素S（SLS）u血平板形成透明溶血环u对氧稳定，无抗原性Department of Micr
7、obiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University侵袭性酶（三种）n透明质酸酶u分解细胞间质的透明质酸，有利于细菌扩散n链激酶（）u使血浆中纤维蛋白酶原转变成纤维蛋白酶，溶解血块或阻止血浆凝固n链道酶（）u降解粘稠的DNA，使脓汁稀薄，有利于细菌扩散“丹毒”蜂窝组织炎 Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University
8、致病物质n细胞壁成分u脂磷壁酸（LTA）uM蛋白n外毒素u致热外毒素（红疹毒素）u溶血素ASOn侵袭性酶u透明质酸酶u链激酶（）u链道酶（）“噬肉菌”患者左手发生坏死性筋膜炎，感染区域剧烈疼痛“丹毒”Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University所致疾病n化脓性感染u皮肤及皮下组织感染：丹毒、蜂窝组织炎、痈等u其它系统感染:扁桃体炎、咽炎、鼻窦炎、中耳炎、产褥热等 n中毒性疾病u猩红热u链球菌毒性休克综合征n变态反应性疾病u风湿热u急
9、性肾小球肾炎面部丹毒Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical Universityerysipelas Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical Universityscarlet feverDepartment of Microbiology,Harbin Medical UniversityDepart
10、ment of Microbiology,Harbin Medical University微生物学检查法n标本n直接涂片镜检 n培养u血琼脂平板，形成典型的溶血现象n抗原的检测 n血清学试验u抗O试验（ASO）uDick试验（Dick test）Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University防治原则n对乙型溶血性链球菌引起的呼吸道、皮肤感染应早期诊断，早期治疗，防止风湿热或急性肾小球肾炎等并发症的发生n对患风湿热的患者应及时给予药物
11、治疗n抗生素对已经形成慢性的肾小球肾炎（或风湿性心脏病）疗效不佳Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University肺炎链球菌Streptococcus pneumoniaePneumococcusDepartment of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University形态与染色n革兰阳性双球菌u直径1m。
12、矛头状，钝端相对u厚荚膜 +u鞭毛 -u芽胞 -u自溶酶 +Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University培养及生化反应n培养特性u需氧或兼性厌氧u营养要求高u在固体培养基上形成“脐状”菌落，胆盐可促其自溶ua溶血环n生化反应u可发酵菊糖，可鉴别肺炎球菌与甲型溶血性链球菌，奥普托欣抑制其生长u胆汁溶菌试验阳性Department of Microbiology,Harbin Medical UniversityDepartment o
13、f Microbiology,Harbin Medical University抗原构造与分型n荚膜多糖抗原u存在于荚膜中，分48个血清型n菌体抗原u C多糖种特异性，各型菌株共有uM蛋白型特异性，刺激机体产生的抗体无保护作用，与毒力无关Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University抵抗力n较弱u对一般消毒剂敏感u加热56，1530min即被杀死n有荚膜菌株抗干燥能力强u干燥痰中可存活1 2个月Department of Microb
14、iology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University致病性与免疫性n致病物质u荚膜u肺炎链球菌溶血素u紫癜形成因子n所致疾病u大叶性肺炎u其他部位炎症n免疫性u牢固的型特异性免疫，同型再次感染少见Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University病菌呼吸道支气管肺组织入血菌血症n突然发病，高热、寒战、胸膜剧痛、咳铁锈色痰，病
15、变常累及单个肺叶，未经治疗70%咳治愈n肺泡内渗出的RBC被吞噬细胞吞噬，崩解后形成的含铁血黄素混入痰中，使痰液呈铁锈色Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University微生物学检查法n标本：痰液脓液血液脑脊液n直接涂片镜检 n分离培养：血琼脂平板n鉴别试验u肺炎链球菌与甲型溶血性链球菌菌落相似，应加以鉴别：菊糖发酵试验；胆汁溶菌试验；奥普托欣试验（optochin test）n肺炎链球菌型别鉴定（荚膜肿胀试验、凝集试验）n动物试验 u小
16、鼠对肺链高度敏感Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical UniversityNot optochin sensitiveoptochin sensitiveIdentificationDepartment of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University其他链球菌nB族链球菌：u新生儿败血症、脑膜炎；孕妇流产、产
17、后败血症等nC族链球菌u多为动物源性疾病，引起密集人口 流行性咽炎等、肺炎、脑膜炎等nD族链球菌u医院内感染重要病原菌n甲型溶血性链球菌（草绿色链球菌）u龋齿u亚急性细菌性心内膜炎Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University教学大纲n掌握内容：链球菌的主要生物学性状及分类；致病物质及所致疾病；微生物学检查法。肺炎链球菌形态染色与培养特性、抗原构造与分型；致病物质及引起疾病。n熟悉内容：链球菌免疫性，SLO和致热外毒素抗体；Dick试
18、验；肺炎链球菌微生物学检查法及防治原则；Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University问题n链球菌的主要分类方法？n化脓性链球菌的主要致病物质及其所致疾病？n肺炎链球菌的主要致病物质及所致疾病？Department of Microbiology,Harbin Medical UniversityDepartment of Microbiology,Harbin Medical University小结n链球菌u链球菌的分类 抗原构造 致病物质 所致疾病 ASO及抗O试验 n肺炎链球菌u荚膜 致病物质 所致疾病 与甲型链球菌的鉴别