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沙眼衣原体有沙眼生物变种性病淋巴肉芽肿生物变种课件

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性病淋巴肉芽肿生物 性病淋巴肉芽肿 沙眼衣原体生物变种 沙眼生物变种 性病淋巴肉芽肿生物变种 沙眼衣原体有
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 第二十六章 衣原体及检验 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 衣 原 体 n是一类专性细胞内寄生、有独特发育周 期、能通过细菌滤器的原核细胞型微生 物。归属于广义的细菌范畴。 n衣原体科包括沙眼衣原体、肺炎衣原体 、鹦鹉热衣原体和家畜衣原体等四种。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 一、沙眼衣原体 n不仅可致眼部感染,而且可引起生殖泌尿系 统感染、性病淋巴肉芽肿以及其他器官疾病 。 n近年沙眼衣原体的感染率和危害性已超过淋 球菌而居性传播疾病之首,因而日益受到医 学界的重视。 n沙眼衣原体有沙眼生物变种、性病淋巴肉芽 肿生物变种(LGV)和鼠生物变种等3个生 物变种。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 1.沙眼亚种 (1)沙眼: 通过眼-手-眼途径直接或间接密切接触传 播。由A、B、Ba和C血清型引起。结膜引 起局部炎症。有滤泡增生。后期出现瘢痕 及角膜血管翳,影响视力。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society (2)包涵体结膜炎: 由B、Ba、D、Da等血清型引起。婴儿通过 产道感染,引起滤泡性结膜炎,不出现角 膜血管翳。 (3)泌尿生殖道感染: 由D-K血清型引起。在性接触传播引起的 非淋菌性泌尿生殖道感染(50%—60%) 。 易发展为持续感染或无症状携带者。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 2.性病淋巴肉芽肿亚种,由L血清型引起 性病淋巴肉芽肿。侵犯腹股沟淋巴结, 引起化脓性淋巴结炎和慢性淋巴肉芽肿 。 3.鼠生物变种为鼠间传播,不侵犯人,与 鼠肺炎有关。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 微生物特性 1.发育周期与形态染色 衣原体具有特殊的发 育周期。①原体是细胞外存在形式,卵圆形 ,有胞壁和拟核, 是发育成熟的衣原体,具有 高度感染性,能吸附于易感细胞特异受体, 增大形成网状体;②网状体或称始体,圆形 ,二分裂增殖为繁殖型,无感染性。于感染 24h后浓缩形成原体,最后细胞破裂释放原体 ,再感染其他细胞,每个发育周期约需48— 72h。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 抗原结构 复杂,有属、种、型等特异性抗原。 (1)属特异性抗原:为胞壁LPS,属特异性补 体结合抗原,应用于血清学诊断。 (2)种特异性抗原:位于主要外膜蛋白 (MOMP)上,可用补体结合试验和中和 试验检测。 (3)型特异性抗原:也位于MOMP上,用单 克隆抗体作微量免疫荧光试验能识别沙眼 体的18个型别。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 培养特性 n沙眼衣原体专性活细胞内寄生,用6—8d龄 鸡胚卵黄囊及各种传代细肋培养。一般培 养48—72h后可在细胞内查到包涵体及原体 和始体颗粒。 n近年多采用细胞培养衣原体,常用的细胞 株为Hela-299和McCoy。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 抵抗力 n沙眼衣原体感染材料在37℃条件下,经48h 左右即失去活力,56℃6 min灭活。-70℃可 保存数年,冷冻干燥可保存30年以上仍有 活性。O.1%甲醛或O.5%石炭酸溶液24h杀 死沙眼衣原体,2%来苏仅需5min。 n红霉素、四环素、强力霉素或青霉素对衣 原体有抑制作用。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 沙眼和包涵体结膜炎病人,用拭子在结 膜上穹窿涂擦或取结膜刮片。性病淋巴肉芽 肿:采淋巴结脓汁,也可取直肠拭子或活检 材料送检。 用光学显微镜观察包涵体有诊断意义, 特别在眼结膜、尿道及子宫颈上皮细胞内发 现典型包涵体更有沙眼衣原体感染的参考。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 免疫学方法 1)免疫荧光检查:用荧光抗体检测上皮细胞 内衣原体抗原。标记抗衣原体LPS抗体, 可与所有衣原体反应;而抗MOMP抗体有 种、型特异性。可在1h内即作出诊断并可 分型。 2)酶免疫检测:能在数小时内检测出衣原体 可溶性抗原,并适用于同时检测大量标本 。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 核酸检测 1)核酸杂交:用125I标记的衣原体rDNA探针检 测宫颈标本的敏感性和特异性,与培养相比 分别为82.8%和99.4%。 2)PCR:具有高度敏感性和特异性。一般按沙 眼衣原体7.5kb质粒、MOMP序列及 16SrRNA基因序列设计引物。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 分离培养 n将标本拭子,用含抗生素的稀释液制成10% -20%悬液。分离的细胞有McCoy、HeLa- 229细胞等。置5%CO2下培养。 n初代分离培养72-96h后传代或盲传。有症状 病人90%标本第1代即可见包涵体,而无症 状病人需传代后才得到阳性。 n敏感性为80%-90%,特异性100%,是目前 确诊最可靠的方法,而且是评价实验室诊断 法的标准。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 鸡胚培养 n有细菌污染的临床标本加适当的抗生素 (如链霉素、庆大霉素和制霉菌素等)肉 汤,在室温中作用lh后,接种3-4只孵育 7天的鸡胚卵黄囊,35℃孵育,观察至 13天,收获卵黄囊涂片,作Gimenez染 色,镜检原体。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 鉴定 1.将细胞培养盖片用Giemsa或碘染色镜检 胞质内包涵体。Giemsa染色比碘染色敏 感,可作为鉴别沙眼衣原体的参考。 2.可用型特异性荧光血清鉴定其型别。对 于卵黄囊和小鼠分离的材料可用免疫荧 光法鉴定原体或补体结合抗原 。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 抗体检测 n目前检测抗体的血清学方法在常规临床诊断中价 值很小。 n原因是不易获得双份血清,而且性传播疾病的高 危人群多有慢性重复感染,原有的抗体水平较高 ,因而限制了血清学方法的诊断价值。 n方法有补体结合试验(CF)、微量免疫荧光试验 (MIF)、酶免疫法等。其中CF敏感性和特异性较 差,而MIF敏感性和特异性较高。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 三、鹦鹉热衣原体 n鹦鹉热衣原体是鹦鹉热的病原体,主要引 起禽畜感染,也可由动物传染到人,引起 肺炎和毒血症,亦有引起心内膜炎的报道 。 n也有衣原体独特的生活周期,包涵体较致 密,形态不一,碘染色阴性,是与沙眼衣 原体鉴别要点 (沙眼衣原体含糖原,碘染 色阳性)。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 抗原检测 1)免疫荧光检查:以衣原体属、种或型的单 克隆抗体与荧光素结合后中衣原体抗原的 存在,用微量免疫荧光法还可用于衣原体 的分型。 2)酶免疫法(EIA)检测:将衣原体单克隆抗 体与酶结合,用于组织或细胞的染色,枪 测衣原体抗原。E1A法比免疫荧光法准确 性略高,且可避免主观因素的影响。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 核酸检测 1)核酸探针检测法:将衣原体MOMP基因、 特异LPS表位基因,及其他决定鹦鹉热衣原 体抗原的基因片段做成探针,对衣原体 DNA进行斑点杂交或Southern印迹杂交试验 ,可准确灵敏测出鹦鹉热衣原体,也可用于 种内株系的鉴别。 2)PCR: 检测3种衣原体的MOMP基因序列是 简便、微量、快速、敏感的检测力法。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 分离培养 (1)鸡胚培养:鹦鹉热衣原体的分离常用鸡胚卵 黄囊接种与传代,可取得满意效果。 (2)小鼠分离:选择腹腔接种、颅内接种和滴鼻 接种进行试验。最具特征性的发现小鼠嗜眠 和麻痹,胀气的十二指肠上覆盖一层薄的粘 性渗出物,全肺叶有实变。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society (3)细胞培养:细胞培养常用PL细胞、BHK细 胞、Vero细胞等,鹦鹉热衣原体均能生长。 但直接用于临床标本的分离培养效果不好, 最好先接种鸡胚卵黄囊,经繁殖后再细胞培 养容易成功。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 抗体检测 方法有补体结合试验(CF)、间接血凝试验 (IHA)和酶联免疫吸附试 (ELISA)等。 补体结合试验:主要用于鹦鹉热和性病淋巴肉 芽肿以及肺炎的试验。CF抗体效价呈4倍增长 者可作诊断。一次CF抗体结果,需效价高于1 : 64才可能作临床诊断。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 四、肺炎衣原体 n肺炎衣原体是衣原体属中的一个新种,只 有一个血清型,是一种重要的呼吸道病原 体。主要引起青少年急性呼吸道感染,可 引起肺炎、支气管炎、咽炎和鼻窦炎等。 n还可引起心包炎、心肌炎和心内膜炎。肺 炎衣原体性感染与急性心肌梗死和慢性冠 心病的关系,越来越引起人们的注意。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 微生物特性 1.有衣原体独特的生活周期,原体在电镜下呈 型的梨形,并有清晰的周浆间隙。 2.全基因组测序已完成,与鹦鹉热衣原体、沙 眼衣原体的DNA同源性≤10%,而不同来 擗TWAR株都具有94%以上的DNA同源性 , 其限制性内切酶的图谱相同。其单克隆抗体 与沙眼衣原体及鹦鹉热衣原体无交叉反应。 3.用HEp-2和HL细胞系较易分离和传代。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 抗体检测 以微量免疫荧光试验(MIF)最为敏感,该试验 阳性者50%~70%可分离出 TWAR,用此法 检测特异性的IgM和IgG抗体,有利于区别近 期感染和既往感染,也有利于区别原发感染 和再感染,TWAR的再感染相当常见,特别 是老年人,再感染时一般不出现lgM和补体结 合抗体。
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本文标题:沙眼衣原体有沙眼生物变种性病淋巴肉芽肿生物变种课件
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