宮內(nèi)感染的病原學(xué)診斷ppt課件

1、CMV宮內(nèi)感染的研討現(xiàn)狀.先天性感染新生兒感染也稱為先天性感染congenital infection) ，主要包括宮內(nèi)感染、產(chǎn)程感染和產(chǎn)后感染，其中宮內(nèi)感染預(yù)后嚴(yán)重。其病原體主要包括：細(xì)菌，如李氏桿菌、軍團(tuán)菌、結(jié)核菌；寄生蟲，如弓形蟲Toxoplasma, TOX；病毒： 風(fēng)疹 (Rubella virus, RUV), 巨細(xì)胞病毒(Cytomegilic virus, CMV), 單純皰疹病毒(Herpessimplex virus, HSV) 乙型肝炎 HBV愛滋病 HIV-1其他病原體，如衣原體、支原體、梅毒；等所致的感染在新生兒期均有共同特點(diǎn)，故國(guó)外簡(jiǎn)稱TORCH 綜合癥。.“T代表

2、弓形蟲Toxoplasma “O代表其他柯薩其病毒，衣原體等Other “R代表風(fēng)疹病毒Rubella ViruS “C代表巨細(xì)胞病毒Cytomegalo ViruS “H代表單純皰疹病毒HerpesStmplex Virus， ToRCH 綜合癥一組優(yōu)生優(yōu)育挑選常用檢測(cè)對(duì)象TORCH綜合癥：是指可導(dǎo)致先天性宮內(nèi)感染及圍產(chǎn)期感染而引起圍產(chǎn)兒畸形的病原體，它是一組病原微生物的英文稱號(hào)縮寫： .宮內(nèi)感染的途徑宮內(nèi)感染有以下幾種途徑：病原體由母體血運(yùn)經(jīng)胎盤而進(jìn)入胎兒血循環(huán)中，或因胎盤炎癥進(jìn)入羊水中。病原體經(jīng)陰道、宮頸上行性感染。胎膜已破者病原體可直接進(jìn)入羊水；假設(shè)未破，那么可經(jīng)胎膜或蛻膜而污染羊水。

3、病原體經(jīng)輸卵管下行性感染，由于絨毛膜、羊膜炎或蛻膜炎進(jìn)入羊水。胎兒感染可由胎兒吞咽羊水至胃腸道內(nèi)或吸入呼吸道內(nèi)而感染。.宮內(nèi)感染的發(fā)病機(jī)制1. 受孕前感染：病原體在孕前即進(jìn)入卵細(xì)胞或精子，受精時(shí)產(chǎn)生先天轉(zhuǎn)錄 其病原體轉(zhuǎn)入受精卵，使胚胎發(fā)育受阻。2. 著床前感染：病原體依賴于生殖細(xì)胞進(jìn)展增殖，導(dǎo)致胚胎畸變，殘疾或流產(chǎn)。3. 著床后感染：感染發(fā)生于妊娠1-3個(gè)月，導(dǎo)致重要器官系統(tǒng)發(fā)育缺陷。.宮內(nèi)感染嚴(yán)重性的影響要素1. 病原體的數(shù)量與毒力2. 母體的免疫形狀：初感時(shí)宿主免疫低下，感染后長(zhǎng)期埋伏于體內(nèi)，當(dāng)宿主免疫力再度下降病原體激活 增殖再染 受感染器官系統(tǒng)損害加重。3. 胎兒成熟度。.巨細(xì)胞病毒

4、(cytomegalovirus, CMV ) .巨細(xì)胞病毒構(gòu)造模擬圖.CMV感染的根本特征CMV infects not only the fibroblasts, but also the majority of body cells.The immune response is focused on two human-CMV proteins, the envelope glycoprotein gB and the phosphoprotein pp65.The virus lacks the enzyme thymidine kinase, therefore it is resi

5、stant to antiviral agents that use this enzyme for their action.Receptor: GEF-Receptor and alpha V integrin; .CMV infects 60% of women of childbearing age in developed countries and 90% in developing countries (Griffiths, P.D. 2002).CMV Infection leaves the patients without symptoms and CMV establis

6、hes latency, except for cases where the hosts immune systemis compromised (AIDS, transplant patients and fetuses).congenital CMV infection can lead to sensorineural hearing loss, mental retardation, and neurologic deficits.CMV感染的流行病學(xué).CMV感染對(duì)胎嬰兒生長(zhǎng)發(fā)育的影響一近期影響：流產(chǎn)、死胎、新生兒死亡，死亡率50%80%；二遠(yuǎn)期：5%出現(xiàn)發(fā)育異常. 表1 PCR檢測(cè)

7、27例畸形及死亡新生兒CMV感染的臟器分布 臟器 受檢數(shù) 陽性數(shù) 陽性率% 胸腺 11 6 54.6 腦 13 7 53.9 肝 26 13 50.0 肺 26 6 23.1 脾 15 3 20.0 腎 25 7 28.0 心 25 2 8.0 淋巴腺 1 0 0 唾液腺 1 1 1/1 合 計(jì) 141 45 31.91 .CMV的傳播途徑血行傳播：輸注血液或血制品 母-嬰間垂直傳播 臟器或組織移植唾液腺傳播：人-人，程度傳播乳汁傳播：哺乳期傳播精液傳播：性接觸傳播.Mother-to-child transmission is mainly the result of primary mat

8、ernal CMV infection which carries a risk of transmission varying from 24% to 75% (mean value 40%) ; Cases of CMV transmission due to non-primary infection have been reported in 12.2% of cases, i.e. at a much lower rate than those resulting from primary infection; (Fowler et al., 1992 CMV的母-嬰傳播途徑.孕婦C

9、MV 感染的診斷；胎兒CMV 宮內(nèi)感染的診斷；CMV 宮內(nèi)感染的診斷.1、病原學(xué)診斷：目前從血、分泌物、體液等標(biāo)本中分別培育出病毒仍是診斷HCMV 感染的金規(guī)范。 PCR法； 病毒培育法; 2、孕婦血清抗體程度的檢測(cè)；血清CMV特異性抗體的亞類鑒定；IgG與IgM血清抗體的親和力測(cè)定；孕婦CMV 感染的診斷.CMV特異性細(xì)胞免疫功能測(cè)定.胎兒超聲學(xué)檢查：胎兒CMV 感染后可有超聲學(xué)異常表現(xiàn),如胎兒生長(zhǎng)受限、腦室腫大、腹水、顱內(nèi)鈣化和羊水量異常(通常為羊水過少) 等；羊膜腔穿刺：CMV 宮內(nèi)感染時(shí),病毒常可累及胎兒腎臟并在其中復(fù)制,含有CMV 的零落細(xì)胞可隨胎兒尿液進(jìn)入羊水中,故羊水中檢出CMV

10、 或其基因片段；臍靜脈穿刺：孕20 周后可在超聲引導(dǎo)下行臍靜脈穿刺，所得胎血除可做病原體分別、基因擴(kuò)增、特異性IgM抗體檢測(cè)外,還可進(jìn)展病毒定量和其它非特異目的的分析,包括血紅蛋白、血小板、嗜酸性細(xì)胞數(shù)等血液學(xué)目的、轉(zhuǎn)氨酶等生化目的；胎兒CMV 宮內(nèi)感染的診斷.固相膜免疫檢測(cè).CMV的防治現(xiàn)狀-Vaccine; Vaccine; Active vaccines have included live attenuated virus, killed virus vaccine, and recombinant vaccines；There are currently twoCMVvaccines

11、 in phase II studies.One is the CMV gB/MF59 vaccine which is disulfide-linked glycoprotein complex (gB) with 130 and 55 kDa components；The other vaccine in human trials is the Towne strain. It is a live attenuated vaccine used extensively in clinical trials and is safe；.Passive Immunization during P

12、regnancy for Congenital Cytomegalovirus Infection;Passive immunization which includes both hyperimmune sera and sera raised against the gB glycoprotein ofgpCMV has also been effective at reducing pup mortality and/or preventing congenital infection；CMV的防治現(xiàn)狀-被動(dòng)免疫治療; .The end.CMV引起的細(xì)胞病變.HCMV感染的免疫學(xué)檢測(cè)HC

13、MV抗原血癥pp65、IE、p150.Ekaterina Maidji J Virol. 2007. .CMV的埋伏感染與再次激活宿主情況(安康或正常) 病毒埋伏(無臨床病癥)- 平衡形狀 (突破平衡) 生物的 物理的 | 化學(xué)的 | 等等 埋伏的病毒 -激活(復(fù)制) .A 64 year old woman had taken oral corticosteroids for 2 years, in treatment of polymyalgia rheumatica. She now presents with abdominal pain and rectal bleeding. En

14、doscopic examination of the colon showed cecal ulcerations, and a partial bowel resection was ultimately undertaken. .HSV-1型所致唇皰疹.水痘-帶狀皰疹病毒感染所致的帶狀皰疹.結(jié)核病的病原體-結(jié)核分枝桿菌.弓形體-蟲卵囊.傳播途徑的表示圖.皰疹病毒(herps virus) 皰疹病毒的電鏡照片.風(fēng)疹病毒感染.梅毒(syphilis)慘白密螺旋體鏡下形狀暗視野)一種性傳播性疾病梅毒螺旋體梅毒亞種感染所致人是獨(dú)一宿主梅毒分先天/獲得性梅毒診治的參考目的: 血清挑選實(shí)驗(yàn) 血清學(xué)確診實(shí)驗(yàn).胎盤粘住頭部 內(nèi)臟外翻畸形斜視、腦癱.孕婦CMV 感染的診斷.免疫球蛋白抗體的種類.用ELISA法檢測(cè)外周血特異性抗體 CMV-IgM、IgG，判別結(jié)果： I