腸道桿菌課件

腸道桿菌腸道桿菌Enterobacteriaceae(腸桿菌科)腸桿菌科目前有44個菌屬、170多個種。多為腸道正常菌群，但可成為條件致病菌；少數(shù)為致病菌。Enterobacteriaceae(腸桿菌科)腸桿菌科目AllbacillibelongingtoEnterobacteriaceae

areshortgram-negativerods,eithermobileornon-mobile.AllbacillibelongingtoEnterAllbacillibelongingtoEnterobacteriaceae

arefacultativeanaerobes.Theygrowincommonmedia.Mostoftheentericbacilliformround,convex,smoothcolonieswithdistinctedges.AllbacillibelongingtoEnterLactose（乳糖）fermentationMechanism:Non-pathogenicentericbacillicanfermentlactosewhilepathogenicentericbacillisuchasShigellaandSalmonellacannot.Media:SS-plateorEMBplate,TSIagarslantsBasiccomponents:

lactoseandapHindicator

TheidentificationofEnterobacteriaceaeislargelydependonbiochemicalreactions

Lactose（乳糖）fermentationMechanResultsSSplateredcoloniesnon-pathogenic/非致病菌whitecoloniespathogenic/致病菌ResultsSSplateredcolonieswhEnterobacteriaceaehavecomplexantigenicstructures.HAg(flagella)

somaticO

Ag

(lipopolysaccharide)K/ViAg(capsule)EnterobacteriaceaehavecompleCommonpathogenicmaterialsforEnterobacteriaceaeinclude:

bacterialstructures(pili,capsule)toxins(enterotoxin,endotoxin)腸道桿菌課件Infectionsoutsidetheintestinescausedbybacterialtranslocation

Opportunisticinfection

includingsepticemia,pneumonia,meningitisandurinarytractinfections

Community-acquiredinfectionurinarytractinfectionsInfectionsoutsidetheintestiE.coliassociatedurinarytractinfectionE.colicausesurinarytractinfectionssuchasacutecystitis（急性膀胱炎）andpyelonephritis（腎盂腎炎）.E.coliassociatedurinarytraInfectionsinsidetheintestinescausedbypathogenicE.coli

CommonsymptomsincludeGastroenteritis（腸胃炎）,diarrhea（腹瀉）anddysentery（痢疾）.

Diseasetransmissionisbyfecal-oralroute（糞口途徑）.

EnterotoxigenicE.coli(ETEC/腸產(chǎn)毒性大腸桿菌)EnteropathogenicE.coli(EPEC/腸致病性大腸桿菌)EnteroinvasiveE.coli(EIEC/腸侵襲型大腸桿菌)EnterohemorrhagicE.coli(EHEC/腸出血性大腸桿菌)EnteroaggregativeE.coli(EAEC/腸集聚性大腸桿菌)InfectionsinsidetheintestinCause"traveller’sdiarrhea".Twotypesofplasmid-encodedtoxinsareproduced:

Heatlabiletoxins(LT/耐熱腸毒素)

activate

adenylcyclase（腺苷環(huán)化酶）whichcatalyzeATPtocAMP

Heatstabletoxins(ST/不耐熱腸毒素)

activateguanylcyclase（鳥苷環(huán)化酶）tocatalyzeGTPtocGMP

cAMP/cGMParetheintracellularsecondmessagers.Theformerincreasesthesecretionofwaterandions,andthelatterinhibitsionicuptake.Clinicalsigns:waterydiarrhea,

feverandnausea.EnterotoxigenicE.coli(ETEC/腸產(chǎn)毒性大腸桿菌)Cause"traveller’sdiarrhea".Commonlyassociatedwithinfantdiarrhea.CharacteristiclesionwithdestructionofmicrovilliwithoutinvasionClinicalsigns:fever,diarrheawithnon-bloodystools,vomitingandnausea.EnteropathogenicE.coli(EPEC/腸致病性大腸桿菌)Commonlyassociatedwithinfa腸道桿菌課件Associatedwithelderchildrenandadultdiarrhea.

WithoutflagellaHighvirulence:asmallnumberofEIECcancauseseriousillnessClinicalsigns:Acuteinflammatoryresponsesandtissuedestruction.Producediarrheawithlittlefluid,muchbloodandmucuscontainingpolymorphonuclearcells.EnteroinvasiveE.coli(EIEC/腸侵襲型大腸桿菌)AssociatedwithelderchildrEHECproducesbacteriophage-mediatedexotoxin.ThistoxiniscalledVerotoxin(VT)becauseofitscytotoxicitytoculturedVerocells.Theillnessischaracterizedbyseriousabdominalpainanddiarrheawhichisinitiallywaterybutthenbecomesbloody.Inchildren,thediseasemaybeprogressedtoasystemicstagecalledashemolyticuremicsyndrome(kidneyinjury)with10%deathrate.EnterohemorrhagicE.coli(EHEC/腸出血性大腸桿菌)EHECproducesbacteriophage-meAdominantserotypeofEHECisE.coli

O157:H7

AdominantserotypeofEHEC

Itcausesapersistent,mucus-waterydiarrheawithvomitinganddehydrationininfants.Itproducesenteroaggregativeheat-stabletoxin(EAST)similartotheheatstabletoxinsofETEC.Itproducesmucousassociatedautoagglutininwhichcausesaggregationofthebacteriaandformationofbiofilm.EnteroaggregativeE.coli(EAEC/腸集聚性大腸桿菌)Itcausesapersistent,mucusE.coli

EnterobacterAerogenesIMViCtestIndoletestMethylred(MR)testVoges-Proskauer(VP)testCitrateutilizationtest枸櫞酸鹽試驗吲哚試驗甲基紅試驗產(chǎn)氣腸桿菌微生物學(xué)檢測防治原則菌毛疫苗E.coliEnterobaQUIZ1主要引起嬰兒和旅行者腹瀉的大腸埃希菌是：腸產(chǎn)毒型大腸埃希菌腸致病型大腸埃希菌腸侵襲型大腸埃希菌腸出血型大腸埃希菌QUIZ1人類細菌性痢疾的最常見病原菌（急性細菌性痢疾，慢性細菌性痢疾）痢疾發(fā)病總數(shù)在前五位，死亡在前十位（傳染病）革蘭氏陰性短小桿菌，無鞭毛，有菌毛，無芽胞，無莢膜O抗原是分類依據(jù)，可以分為4群（種），40余個血清型（包括亞型）致病性：黏附、侵襲、胞內(nèi)繁殖、細胞間擴散Shigella志賀菌屬人類細菌性痢疾的最常見病原菌ShigellaSalmonella

沙門菌屬Salmonella

急性消化道傳染病，我國乙類傳染病Entericfever(typhoidfever)isthemostseriousformofsalmonellainfectionwhichonlyoccursinhumanCarrierstateiscommonInuntreatedpatients,thedeathrateis7%to14%Antibiotictherapyisessential,vaccinesarenoteffectiveandnotwidelyused腸熱癥(傷寒、副傷寒)腸熱癥(傷寒、副傷寒)Themicrobeinitiallyinvadesintestinalmucosalepitheliumandpropagateatthelocal.Themicrobepenetratesintothebloodstreamtocausethefirstroundofbacteremiawithsymptomsoffever,generaldiscomfortandpain.Themicrobeentersmanyorganssuchasliver,spleen,kidney,gallandmarrowforfurtherpropagation.Themicrobepenetratesintothebloodstreamagaintocausethesecondroundofbacteremiawithserioussymptomsofhighfever,swellofspleenandliver,rose-coloredspotsinskin,andtissueinjury.entericfeverdevelopmentThemicrobeinitiallyinvades1.致病菌S.typhi（傷寒沙門菌）S.paratyphiA（甲型副傷寒桿菌）S.schottmuelleri（肖式沙門菌）S.hirschfeldii（希式沙門菌）entericfeverDiagnosis2.標本采集Blood@firstweekStoolandurine@fromthesecondweekonMarrowcanbeconsideredbecauseofitshighandpermanentpositiveresults.1.致病菌entericfeverDiagnosisentericfeverdiagnosis3.Widaltest（肥達試驗）aquantitativeagglutinationtestusingtheknownOantigenofS.typhi,andHantigensofS.typhiandS.paratyphi

A/Btodetectspecificserumantibodies.

Foronesingleserumsample,

Thetitersofanti-OantigenIgM1:80and/oranti-HantigenIgG1:160.Fortwoserumsamplesthatcollectedwithanintervalof5~7days,4-foldincreaseintitersofspecificantibody.entericfeverdiagnosis3.Wida沙門菌引起的其它疾病急性胃腸炎(食物中毒，Gastroenteritis/food-poisoning)敗血癥ItisthemostcommonSalmonellainfectionandusuallytransmittedfromcontaminatedfood.However,onlyafewoffoodpoisoning-causingsalmonellaserotypescanproduceenterotoxin.ManySalmonellaserotypescancausesepticemia.Thisdiseaseiscommonlyfoundinchildrenoradultwithlowimmunity.

沙門菌引起的其它疾病急性胃腸炎(食物中毒，GastroentQUIZ2腸熱癥發(fā)病一周內(nèi)，進行病原性診斷應(yīng)選擇：尿培養(yǎng)血培養(yǎng)糞便培養(yǎng)肥達試驗QUIZ2Helicobacterpylori

幽門螺桿菌Helicobacterpylori

慢性胃炎，消化性潰瘍，胃癌2005諾貝爾獎獲得者BarryMarshall，RobinWarren于1983年，從胃炎組織標本中分離出幽門螺桿菌，并證實該菌是胃炎及消化道潰瘍的病原菌慢性胃炎，消化性潰瘍，胃癌2005諾貝爾獎獲得者Barry一端有2-6根鞭毛，運動活潑的革蘭氏陰性螺桿菌主要生化鑒定依據(jù)：脲素酶、過氧化氫酶、氧化酶均為陽性一端有2-6根鞭毛，運動活潑的革蘭氏陰性螺桿菌腸道桿菌腸道桿菌Enterobacteriaceae(腸桿菌科)腸桿菌科目前有44個菌屬、170多個種。多為腸道正常菌群，但可成為條件致病菌；少數(shù)為致病菌。Enterobacteriaceae(腸桿菌科)腸桿菌科目AllbacillibelongingtoEnterobacteriaceae

areshortgram-negativerods,eithermobileornon-mobile.AllbacillibelongingtoEnterAllbacillibelongingtoEnterobacteriaceae

arefacultativeanaerobes.Theygrowincommonmedia.Mostoftheentericbacilliformround,convex,smoothcolonieswithdistinctedges.AllbacillibelongingtoEnterLactose（乳糖）fermentationMechanism:Non-pathogenicentericbacillicanfermentlactosewhilepathogenicentericbacillisuchasShigellaandSalmonellacannot.Media:SS-plateorEMBplate,TSIagarslantsBasiccomponents:

lactoseandapHindicator

TheidentificationofEnterobacteriaceaeislargelydependonbiochemicalreactions

Lactose（乳糖）fermentationMechanResultsSSplateredcoloniesnon-pathogenic/非致病菌whitecoloniespathogenic/致病菌ResultsSSplateredcolonieswhEnterobacteriaceaehavecomplexantigenicstructures.HAg(flagella)

somaticO

Ag

(lipopolysaccharide)K/ViAg(capsule)EnterobacteriaceaehavecompleCommonpathogenicmaterialsforEnterobacteriaceaeinclude:

bacterialstructures(pili,capsule)toxins(enterotoxin,endotoxin)腸道桿菌課件Infectionsoutsidetheintestinescausedbybacterialtranslocation

Opportunisticinfection

includingsepticemia,pneumonia,meningitisandurinarytractinfections

Community-acquiredinfectionurinarytractinfectionsInfectionsoutsidetheintestiE.coliassociatedurinarytractinfectionE.colicausesurinarytractinfectionssuchasacutecystitis（急性膀胱炎）andpyelonephritis（腎盂腎炎）.E.coliassociatedurinarytraInfectionsinsidetheintestinescausedbypathogenicE.coli

CommonsymptomsincludeGastroenteritis（腸胃炎）,diarrhea（腹瀉）anddysentery（痢疾）.

Diseasetransmissionisbyfecal-oralroute（糞口途徑）.

EnterotoxigenicE.coli(ETEC/腸產(chǎn)毒性大腸桿菌)EnteropathogenicE.coli(EPEC/腸致病性大腸桿菌)EnteroinvasiveE.coli(EIEC/腸侵襲型大腸桿菌)EnterohemorrhagicE.coli(EHEC/腸出血性大腸桿菌)EnteroaggregativeE.coli(EAEC/腸集聚性大腸桿菌)InfectionsinsidetheintestinCause"traveller’sdiarrhea".Twotypesofplasmid-encodedtoxinsareproduced:

Heatlabiletoxins(LT/耐熱腸毒素)

activate

adenylcyclase（腺苷環(huán)化酶）whichcatalyzeATPtocAMP

Heatstabletoxins(ST/不耐熱腸毒素)

activateguanylcyclase（鳥苷環(huán)化酶）tocatalyzeGTPtocGMP

cAMP/cGMParetheintracellularsecondmessagers.Theformerincreasesthesecretionofwaterandions,andthelatterinhibitsionicuptake.Clinicalsigns:waterydiarrhea,

feverandnausea.EnterotoxigenicE.coli(ETEC/腸產(chǎn)毒性大腸桿菌)Cause"traveller’sdiarrhea".Commonlyassociatedwithinfantdiarrhea.CharacteristiclesionwithdestructionofmicrovilliwithoutinvasionClinicalsigns:fever,diarrheawithnon-bloodystools,vomitingandnausea.EnteropathogenicE.coli(EPEC/腸致病性大腸桿菌)Commonlyassociatedwithinfa腸道桿菌課件Associatedwithelderchildrenandadultdiarrhea.

WithoutflagellaHighvirulence:asmallnumberofEIECcancauseseriousillnessClinicalsigns:Acuteinflammatoryresponsesandtissuedestruction.Producediarrheawithlittlefluid,muchbloodandmucuscontainingpolymorphonuclearcells.EnteroinvasiveE.coli(EIEC/腸侵襲型大腸桿菌)AssociatedwithelderchildrEHECproducesbacteriophage-mediatedexotoxin.ThistoxiniscalledVerotoxin(VT)becauseofitscytotoxicitytoculturedVerocells.Theillnessischaracterizedbyseriousabdominalpainanddiarrheawhichisinitiallywaterybutthenbecomesbloody.Inchildren,thediseasemaybeprogressedtoasystemicstagecalledashemolyticuremicsyndrome(kidneyinjury)with10%deathrate.EnterohemorrhagicE.coli(EHEC/腸出血性大腸桿菌)EHECproducesbacteriophage-meAdominantserotypeofEHECisE.coli

O157:H7

AdominantserotypeofEHEC

Itcausesapersistent,mucus-waterydiarrheawithvomitinganddehydrationininfants.Itproducesenteroaggregativeheat-stabletoxin(EAST)similartotheheatstabletoxinsofETEC.Itproducesmucousassociatedautoagglutininwhichcausesaggregationofthebacteriaandformationofbiofilm.EnteroaggregativeE.coli(EAEC/腸集聚性大腸桿菌)Itcausesapersistent,mucusE.coli

EnterobacterAerogenesIMViCtestIndoletestMethylred(MR)testVoges-Proskauer(VP)testCitrateutilizationtest枸櫞酸鹽試驗吲哚試驗甲基紅試驗產(chǎn)氣腸桿菌微生物學(xué)檢測防治原則菌毛疫苗E.coliEnterobaQUIZ1主要引起嬰兒和旅行者腹瀉的大腸埃希菌是：腸產(chǎn)毒型大腸埃希菌腸致病型大腸埃希菌腸侵襲型大腸埃希菌腸出血型大腸埃希菌QUIZ1人類細菌性痢疾的最常見病原菌（急性細菌性痢疾，慢性細菌性痢疾）痢疾發(fā)病總數(shù)在前五位，死亡在前十位（傳染病）革蘭氏陰性短小桿菌，無鞭毛，有菌毛，無芽胞，無莢膜O抗原是分類依據(jù)，可以分為4群（種），40余個血清型（包括亞型）致病性：黏附、侵襲、胞內(nèi)繁殖、細胞間擴散Shigella志賀菌屬人類細菌性痢疾的最常見病原菌ShigellaSalmonella

沙門菌屬Salmonella

急性消化道傳染病，我國乙類傳染病Entericfever(typhoidfever)isthemostseriousformofsalmonellainfectionwhichonlyoccursinhumanCarrierstateiscommonInuntreatedpatients,thedeathrateis7%to14%Antibiotictherapyisessential,vaccinesarenoteffectiveandnotwidelyused腸熱癥(傷寒、副傷寒)腸熱癥(傷寒、副傷寒)Themicrobeinitiallyinvadesintestinalmucosalepitheliumandpropagateatthelocal.Themicrobepenetratesintothebloodstreamtocausethefirstroundofbacteremiawithsymptomsoffever,generaldiscomfortandpain.Themicrobeentersmanyorganssuchasliver,spleen,kidney,gallandmarrowforfurtherpropagation.Themicrobepenetratesintothebloodstreamagaintocausethesecondroundofbacteremiawithserioussymptomsofhighfever,swellofspleenandliver,rose-coloredspotsinskin,andtissueinjury.entericfeverdevelopmentThemicrobeinitiallyinvades1.致病菌S.typhi（傷寒沙門菌）S.paratyphiA（甲型副傷寒桿菌）S.schottmuelleri（肖式沙門菌）S.hirschfeldii（希式沙門菌）