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1、,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
2、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
3、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
4、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
5、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. Demonstrati
6、ng 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 illne
7、ss), 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,Curre
8、nt 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 le
9、sions 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 In
10、fections 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, to
11、ngue, 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 antivira
12、l 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
13、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,