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1、腸道病毒第三篇醫(yī)學(xué)相關(guān)病毒第31章腸道感染病毒Gastrointestine-InfectedViruses微生物學(xué)教研室鐘照華教學(xué)大綱掌握內(nèi)容腸道病毒種類及共同特性脊髓灰質(zhì)炎病毒主要生物學(xué)性狀、致病性、微生物學(xué)檢查法及防治原則柯薩奇病毒分組、分型及致病性熟悉內(nèi)容?？刹《?、腸道病毒70型、腸道病毒71型的致病性Morphology27nm,icosahedralsymmetry,noenvelopeEnterovirusstructureSurfacecleft–attachmenttocellularreceptors:Immunoglobulinsuperfamily,
2、integrins,ICAM-1腸道病毒特點(diǎn)生物學(xué)性狀小球形病毒（~30nm），無包膜核酸為+ssRNA，有感染性衣殼蛋白VP1-VP3分布在表面，VP4與RNA結(jié)合在胞漿增殖，有明顯CPE，破胞釋放耐酸耐乙醚，但鼻病毒除外引起多種疾病麻痹、無菌性腦膜炎、心肌損傷、腹瀉、皮疹脊髓灰質(zhì)炎病毒（Poliovirus）Firstidentifiedin1909byinoculationofspecimensintomonkeysFirstgrownincellculturein1949whichbecamethebasisforvaccinesTransmissionFecal–
3、oralroute(糞－口途徑)viahandsandobjectsviafoodandwaterThefirstwrittenrecordofvirusinfectionAheiroglyphfromMemphis,drawninapproximately1400BC,whichdepictsatemplepriestcalledSiptahshowingtypicalclinicalsignsofparalyticpoliomyelitisFranklinD.RooseveltInthesummerof1921,whenhewas39,disasterhit-hewas
4、strickenwithpoliomyelitis.Demonstratingindomitablecourage,hefoughttoregaintheuseofhislegs,particularlythroughswimming.ManifestationsMostinfectionsasymptomatic,95%Abortivepolio(minorillness),5%fever,malaise,sorethroat,myalgia,headacheAsepticmeningitis(nonparalyticpolio),1%Paralyticpolio(maj
5、orillness),0.1%asymetricflaccidparalysis/paresis.Lower,orupperextremitiesPost-poliosyndromeprogressiveatrophyyearslater免疫性牢固特異免疫，體液免疫為主腸道局部sIgA血液中和性IgG、IgM抗體中和抗體可長時(shí)間維持（終生）3型間交叉保護(hù)極弱LaboratoryDiagnosisVirusIsolationSerology預(yù)防原則流行期不宜做小兒扁挑體摘除術(shù)和其他疫苗接種疫苗接種：最好的手段被動(dòng)免疫：易感者用丙種球蛋白CurrentStatusofWildP
6、oliovirusTransmission我國政府規(guī)定每年12月5日和1月5日為脊灰疫苗日?？滤_奇病毒（Coxsackievirus）1948年美國紐約州Coxsackie鎮(zhèn)一名疑似脊髓灰質(zhì)炎的患兒糞便中用乳鼠接種的方法分離發(fā)現(xiàn)GroupsGroupAviruses(23types)GroupBviruses(6types)DistinguishedfromotherenterovirusesbytheirpathogenicityforsucklingmiceGroupbasedonthelesionsinsucklingmice.PathogenesisFecal-Or
7、alroutetrasmissionSpreadinthebodylikepoliovirusesDiseaseAssociationsParalyticDiseaseMeningitisEncephalitisUndifferentiatedfebrileillnessHandfootmouthdiseaseHerpanginaEpidemicPleurodynia(Bornholmdisease)MyocarditisRespiratoryInfectionsRubelliformrashesNeonatalI
