微生物沙门菌属.ppt

Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,*,Department of Microbiology,Harbin Medical University,*,第二篇 致病性细菌,第16章沙门菌属,Salmonella,微生物学教研室 张文莉,Department of Microbiology,Harbin Medical University,教学大纲,掌握,沙门菌抗原构造与分类,沙门菌致病物质及所致疾病,沙门菌感染的微生物学检查法,肥达反应原理及结果判定分析,熟悉,肠热症的特异性预防,Department of Microbiology,Harbin Medical University,问题,对肠热症患者进行微生物学检查时采取标本应注意什么？,根据O抗体和H抗体的哪些不同特点来判断肥大反应？,Department of Microbiology,Harbin Medical University,Department of Microbiology,Harbin Medical University,Department of Microbiology,Harbin Medical University,鼠伤寒沙门菌,Department of Microbiology,Harbin Medical University,抗原构造与分类,成分,抵抗力,产生抗体,制备,组成,O抗原,LPS,耐湿热,IgM,酒精处理或加热,分组依据：,引起人类沙门菌病的多属A-E组,H抗原,蛋白质,不耐热,IgG,甲醛固定后使O抗原被遮盖,有两种：,第1相为特异相，第2相非特异相,Vi抗原,Department of Microbiology,Harbin Medical University,抗原构造,Department of Microbiology,Harbin Medical University,主要沙门菌的生化特性,菌名,葡萄糖,乳糖,甘露醇,硫化氢,动力,甲型副伤寒沙门菌,肖氏沙门菌,鼠伤寒沙门菌,希氏沙门菌,猪霍乱沙门菌,伤寒沙门菌,肠炎沙门菌,+,+,/+,+,+,+,+/,/+,+,+,+,+,+,+,+,+,Department of Microbiology,Harbin Medical University,抵抗力,较差,水中能存活2-3W,粪便中可活1-2个月,冰冻土壤中可过冬,耐受胆盐、煌绿及其他染料,对热耐力差,Department of Microbiology,Harbin Medical University,致病物质,侵袭力,菌毛、O和Vi抗原抗吞噬,内毒素,引起体温升高、白细胞数下降。大剂量可导致中毒和休克,炎症,肠毒素,某些沙门菌如鼠伤寒沙门菌,Department of Microbiology,Harbin Medical University,所致疾病-人类沙门菌病,肠热症,伤寒、副伤寒,伤寒、甲型副伤寒、肖氏、希氏沙门菌引起,胃肠炎（食物中毒）,鼠伤寒沙门菌、肠炎沙门菌、猪霍乱沙门菌,败血症,鼠伤寒沙门菌、肠炎沙门菌、猪霍乱沙门菌、希氏沙门菌,无症状带菌者,Department of Microbiology,Harbin Medical University,Department of Microbiology,Harbin Medical University,Department of Microbiology,Harbin Medical University,肠热症,胸导管,肠系膜淋巴结,胸导管,全身疼痛、不适发热,（前驱期）,菌血症,肝、脾、肾及胆囊等,吞噬细胞吞噬,胆囊,肾脏,持续高热、肝脾肿大、全身中毒、玫瑰疹,（发病的第1W,）,菌血症,进入肠壁淋巴组织,粪便,尿,并发症：,肠穿孔、血栓性静脉炎、胆囊炎,典型病例病程为3-4W,孤立和集合淋巴结坏死溃疡,Department of Microbiology,Harbin Medical University,伤寒表现,持续高热,伤寒病容,玫瑰疹肝脾肿大,相对缓脉,Department of Microbiology,Harbin Medical University,伤寒玛丽,Department of Microbiology,Harbin Medical University,免疫性,肠热症后，能获得牢固免疫,即使发生，症状也轻，很少发生再感染,细胞免疫较重要,Department of Microbiology,Harbin Medical University,微生物学检查法,标本,胃肠炎取粪便呕吐物或可疑食物,肠热症在病程不同阶段采取不同标本分离培养和鉴定,粪、尿（沉渣）可直接接种选择培养基。,血清学诊断,肥达反应,带菌者检查,Department of Microbiology,Harbin Medical University,Department of Microbiology,Harbin Medical University,肥达反应（,Widal reaction,）,用已知伤寒沙门菌O、H和甲型副沙寒沙门菌和肖氏沙门菌H抗原与病人血清做定量凝集试验，用以辅助诊断肠热症,Department of Microbiology,Harbin Medical University,H与O抗体的性质及其消长意义,抗体类型,体内出现,情况,体内出现情况,O抗体,IgM,出现较早，,维持时间短,高,高,低,H抗体,IgG,出现较晚，维持时间长,高,低,高,患肠热症可能性大,感染早期、,其他沙门菌引起的交叉反应,预防接种；非特异性回忆反应,Department of Microbiology,Harbin Medical University,判定结果时，应着重考虑：,正常凝集价,伤寒沙门菌O抗体的凝集价1：80以上，H抗体1：160以上,甲型副伤寒、肖氏沙门菌H抗体凝集价在1：80以上,动态观察,O与H抗体的诊断意义,Department of Microbiology,Harbin Medical University,Department of Microbiology,Harbin Medical University,防治原则,加强水源和食品卫生管理,疫苗,伤寒、甲及乙型副伤寒3联菌苗,Ty2la伤寒沙门菌口服活菌苗,伤寒Vi荚膜多糖疫苗,治疗,以氯霉素效果较好,Department of Microbiology,Harbin Medical University,小结：沙门菌,O、H抗原,致病性及机制,血清学诊断、肥达反应及其意义,微生物学检查法,防治原则,Department of Microbiology,Harbin Medical University,