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1、Department of Microbiology, Harbin Medical UniversityMedical MicrobiologyDepartment of Microbiology,Department of Microbiology, HMUHMUDepartment of Microbiology, Harbin Medical University第三篇 医学相关病毒第31章 肠道感染病毒Gastrointestine-Infected Viruses微生物学教研室微生物学教研室 钟照华钟照华Department of Microbiology, Harbin Medi
2、cal University教学大纲n n掌握内容uu肠道病毒种类及共同特性肠道病毒种类及共同特性uu脊髓灰质炎病毒主要生物学性状、致病性、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微生物学检查法及防治原则uu柯萨奇病毒分组、分型及致病性柯萨奇病毒分组、分型及致病性 n n熟悉内容uu埃可病毒、肠道病毒埃可病毒、肠道病毒7070型、肠道病毒型、肠道病毒7171型型的致病性的致病性 Department of Microbiology, Harbin Medical University问题n n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？n n简要说明肠道病毒的
3、特性n n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？n nB组柯萨奇病毒的致病有何特点？n nECHO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？Department of Microbiology, Harbin Medical UniversityGroups and Serotypesn nPicornaviridaePicornaviridae（小小RNARNA病毒科）病毒科）n nAt least 71 serotypes, divided into 4 At least 71 serotypes, divided into 4 subgroupssubg
4、roupsuuPolioviruses Polioviruses （脊髓灰质炎病毒）脊髓灰质炎病毒）uuCoxsackie virusesCoxsackie viruses（柯萨奇病毒）柯萨奇病毒）uuEchovirusesEchoviruses（埃可病毒）埃可病毒）uuNew New enterovirusesenteroviruses（新肠道病毒）新肠道病毒）vvmore recently, new more recently, new enterovirusesenteroviruses subtype have been subtype have been allocated sequ
5、ential numbers (68-71)allocated sequential numbers (68-71)Department of Microbiology, Harbin Medical UniversityEnteroviruses SerotypesDepartment of Microbiology, Harbin Medical UniversityMorphology2727nm, nm, icosahedralicosahedral symmetry, no envelope symmetry, no envelopeDepartment of Microbiolog
6、y, Harbin Medical UniversityEnterovirus structureSurface cleft attachment to cellular receptors:Immunoglobulin superfamily, integrins, ICAM-1Department of Microbiology, Harbin Medical UniversityDepartment of Microbiology, Harbin Medical UniversityDepartment of Microbiology, Harbin Medical University
7、Department of Microbiology, Harbin Medical UniversityDepartment of Microbiology, Harbin Medical University肠道病毒特点n n生物学性状生物学性状uu小球形病毒（小球形病毒（ 30 30 nmnm），），无包膜无包膜uu核酸为核酸为+ +ssRNAssRNA，有感染性有感染性uu衣壳蛋白衣壳蛋白VP1-VP3VP1-VP3分布在表面，分布在表面，VP4VP4与与RNARNA结合结合uu在胞浆增殖，有明显在胞浆增殖，有明显CPECPE，破胞释放破胞释放n n耐酸耐乙醚，但鼻病毒除外耐酸耐乙醚，
8、但鼻病毒除外n n引起多种疾病引起多种疾病uu麻痹、无菌性脑膜炎、心肌损伤、腹泻、皮疹麻痹、无菌性脑膜炎、心肌损伤、腹泻、皮疹Department of Microbiology, Harbin Medical University脊髓灰质炎病毒（Poliovirus）n nFirst identified in First identified in 19091909 by inoculation of by inoculation of specimens into specimens into monkeysmonkeysn nFirst grown in cell First grow
9、n in cell culture in culture in 19491949 which which became the basis for became the basis for vaccinesvaccinesDepartment of Microbiology, Harbin Medical UniversityTransmissionn nFecal oral route (粪口途径)uuvia hands and objectsvia hands and objectsuuvia food and watervia food and waterDepartment of Mi
10、crobiology, Harbin Medical UniversityDepartment of Microbiology, Harbin Medical UniversityDepartment of Microbiology, Harbin Medical Universityn nThe first written recordThe first written record of of virus infection virus infection uuA A heiroglyphheiroglyph from Memphis, from Memphis, drawn in app
11、roximately drawn in approximately 1400BC, which depicts a 1400BC, which depicts a temple priest called temple priest called SiptahSiptah showing typical clinical signs showing typical clinical signs of paralytic poliomyelitisof paralytic poliomyelitisDepartment of Microbiology, Harbin Medical Univer
12、sityFranklin D. Rooseveltn nIn the summer of 1921, when he In the summer of 1921, when he was 39, disaster hit-he was was 39, disaster hit-he was stricken with poliomyelitis. stricken with poliomyelitis. Demonstrating indomitable Demonstrating indomitable courage, he fought to regain the courage, he
13、 fought to regain the use of his legs, particularly through use of his legs, particularly through swimming. swimming. Department of Microbiology, Harbin Medical UniversityManifestationsn nMost infections asymptomatic, 95%Most infections asymptomatic, 95%n nAbortive polio (minor illness), 5%Abortive
14、polio (minor illness), 5%uufever, malaise, sore throat, fever, malaise, sore throat, myalgiamyalgia, headache, headachen nAseptic meningitis (non paralytic polio), 1%Aseptic meningitis (non paralytic polio), 1%n nParalytic polio (major illness), 0.1%Paralytic polio (major illness), 0.1%uuasymetricas
15、ymetric flaccid paralysis / paresis. Lower, or flaccid paralysis / paresis. Lower, or upper extremitiesupper extremitiesn nPost-polio syndromePost-polio syndromeuuprogressive atrophy years laterprogressive atrophy years laterDepartment of Microbiology, Harbin Medical UniversityDepartment of Microbio
16、logy, Harbin Medical University免疫性n n牢固特异免疫，体液免疫为主uu肠道局部肠道局部sIgAsIgAuu血液中和性血液中和性IgGIgG、IgMIgM抗体抗体uu中和抗体可长时间维持（终生）中和抗体可长时间维持（终生）n n3型间交叉保护极弱Department of Microbiology, Harbin Medical UniversityLaboratory Diagnosisn nVirus Isolationn nSerologyDepartment of Microbiology, Harbin Medical University预防原则n
17、n流行期不宜做小儿扁挑体摘除术和其他疫苗接种n n疫苗接种：最好的手段n n被动免疫：易感者用丙种球蛋白Current Status of Wild Poliovirus TransmissionCurrent Status of Wild Poliovirus TransmissionDepartment of Microbiology, Harbin Medical Universityn n我国政府规定每年12月5日和1月5日为脊灰疫苗日。Department of Microbiology, Harbin Medical University柯萨奇病毒（Coxsackievirus）n
18、 n1948年美国纽约州Coxsackie镇uu一名疑似脊髓灰质炎的患儿粪便中用乳鼠接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种的方法分离发现Department of Microbiology, Harbin Medical UniversityGroupsn nGroup A viruses (23 types) n nGroup B viruses (6 types)uuDistinguished from otherDistinguished from other enteroviruses enteroviruses by by theirtheir pathogeni
19、city pathogenicity for suckling mice for suckling miceuuGroup based on the lesions in suckling mice.Group based on the lesions in suckling mice.Department of Microbiology, Harbin Medical UniversityPathogenesisn nFecal-Oral route trasmissionn nSpread in the body like poliovirusesDepartment of Microbi
20、ology, Harbin Medical UniversityDepartment of Microbiology, Harbin Medical UniversityDepartment of Microbiology, Harbin Medical UniversityDepartment of Microbiology, Harbin Medical UniversityDisease Associationsn nParalytic DiseaseParalytic Diseasen nMeningitis Meningitis n nEncephalitis Encephaliti
21、s n nUndifferentiated febrile illness Undifferentiated febrile illness n nHand foot mouth diseaseHand foot mouth diseasen nHerpanginaHerpanginan nEpidemic Epidemic PleurodyniaPleurodynia ( (BornholmBornholm disease) disease)Department of Microbiology, Harbin Medical Universityn nMyocarditis n nRespi
22、ratory Infections n nRubelliform rashes n nNeonatal Infection n nConjunctivitis n nPancreatitis/DiabetesDepartment of Microbiology, Harbin Medical UniversityExanthems - Rubelliform rashes n nEV leading cause in summer & fall. All types EV leading cause in summer & fall. All types of rashof rashDepar
23、tment of Microbiology, Harbin Medical UniversityHand-foot-and-mouth diseasen nHand-foot-and-mouth Hand-foot-and-mouth disease: mostly disease: mostly coxackiecoxackie A Auufever, malaise, sore fever, malaise, sore throat, vesicles on throat, vesicles on bucalbucal mucosa, tongue, mucosa, tongue, han
24、ds, feet, buttockshands, feet, buttocksn nhighly infectioushighly infectiousn nresolution 1wresolution 1wDepartment of Microbiology, Harbin Medical UniversityHerpanginan nHerpanginaHerpangina usually usually coxackiecoxackie A Auuacute onset, fever, sore acute onset, fever, sore throat, throat, dysp
25、hagia dysphagia uulesions posterior lesions posterior pharynxpharynxuucan persist wscan persist wsuuno gingivitisno gingivitisDepartment of Microbiology, Harbin Medical UniversityLaboratory Diagnosisn nVirus Isolationn nSerologyDepartment of Microbiology, Harbin Medical UniversityManagement and Prev
26、entionn nThere is no specific antiviral therapy available against enteroviruses other than polio.n nIVIG n nHNIGn nThere is no vaccineDepartment of Microbiology, Harbin Medical UniversityEchovirusesn nThe first echoviruses were accidentally discovered in 1951 during epidemiological studies of poliov
27、iruses.n nCPE in cell culturesDepartment of Microbiology, Harbin Medical UniversityTypesn nThere are 32 echoviruses n nNo group AgDepartment of Microbiology, Harbin Medical UniversityPathogenesisn n主要导致无菌性脑炎、类脊髓灰质炎等n n感染后对同型病毒可产生持久免疫n n诊断困难n n尚无疫苗uu预防以隔离为主预防以隔离为主Department of Microbiology, Harbin Me
28、dical UniversityNew Enterovirusesn n4 new enteroviruses (68 - 72) n nEnterovirus 71 uuappears appears to to be be highly highly pathogenic pathogenic and and has has been been associated associated with with epidemics epidemics of of a a variety variety of acute diseasesof acute diseasesn nEnterovir
29、us 72 uuwas was assigned assigned to to a a new new family family called called heptovirusesheptovirusesDepartment of Microbiology, Harbin Medical UniversityDiseases associated with EnterovirusesDepartment of Microbiology, Harbin Medical UniversityViruses Caused Acute Gastroenteritisn nRotavirusn nH
30、uman Calicivirus, HuCVn nSmall Round Structure Virus, SRSVn nAstrovirusn nEnteric Adenvirus, EAdVDepartment of Microbiology, Harbin Medical UniversityRotavirusesDepartment of Microbiology, Harbin Medical UniversitySmall Round Structure VirusDepartment of Microbiology, Harbin Medical University小结n n肠道病毒种类及共同特性n n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n n柯萨奇病毒分组、分型及致病性 n n埃可病毒、肠道病毒70型、肠道病毒71型的致病性
