5章细菌感染的检查与防治-课件7.ppt

1、 Signs and symptoms vary according to Signs and symptoms vary according to the site and severity of infection.the site and severity of infection.Diagnosis requires a composite of Diagnosis requires a composite of information,including information,including history,physical history,physical examinati

2、on,radiographic findings,and examination,radiographic findings,and laboratory data.laboratory data.laboratory Assays Morphological assaysMorphological assaysLight or electron microscopyLight or electron microscopy Isolation and differentiationIsolation and differentiation Serological assaysSerologic

3、al assaysAntigen-antibody assays Antigen-antibody assays Molecular assaysMolecular assaysMicroorganisms gene(DNA&RNA)Microorganisms gene(DNA&RNA)Diagnosis of Etiology:Diagnosis of Etiology:Golden standardGolden standard is to detect the is to detect the pathogenic bacterium pathogenic bacterium Spec

4、imen Collection and ProcessingnObtain specimens from the infected siteObtain specimens from the infected sitenAvoid contamination from the normal floraAvoid contamination from the normal floranTransporting and storing correctlyTransporting and storing correctlynBefore antimicrobial drugs are adminis

5、tered.Before antimicrobial drugs are administered.nProviding essential informationProviding essential information General procedure for collecting and processing specimens for aerobic and/or anaerobic bacterial culture Direct assayu Morphological Assayu Element Assayu Toxin Assayu Morphological Assa

6、ynNon-stained microscopic observationqDark-field microscopyqObserving the movement of live bacterianStained microscopic observationsqGram stainqAcid-fast stainqFluorescence stain u Element AssaynAntigen detectionnNucleic acid detectionnToxin detectionnAntigen detectionqCoagglutination testqPrecipita

7、tion testqELISAqFluoroimmunoassay,FIA qRadioimmunoassay,RIACoagglutination testPrecipitation testFluoroimmunoassay,FIAnNucleic acid detectionqNucleotide hybridizationqPCRqGene chipPCRGene Chip/microarraynToxin detectionqEndotoxin detection -Limulus testqExotoxin detection -Elek plate testqAnimal tes

8、t -LD50,ID50Limulus testElek plate test Culture&Identifyu Isolation&Cultureu Identifyu Isolation&Culture:ColonynSizenShapenColornSurface featuresqSmooth-RoughnTransparencynHemolysisu Biochemical Reactions Sugar Fermentation H2S Test Citrate utilization u MIC&MBCnMinimum Inhibitory Concentration，MICn

9、Minimum Bactericidal Concentration，MBCnBactericidal drugs usually have an MBC equal or very similar to the MICnBacteriostatic drugs usually have an MBC significantly higher than the MIC E testDiffusion method +Dilution method Serological Diagnosis Detection antibodies in the patients serum u Aggluti

10、nation testu SpeciesPreventionArtificialimmunityInnateimmunityActive immunityPassive immunity Specific PreventionActive immunityPassive immunityPreventionPassiveimmunityActiveimmunityVaccinesAdjuvantsCytokine,LAK cellAntiserum,AntitoxinsToxoidsImmunoglobulinu Artificial active immunityVaccinesInacti

11、vated vaccinesLive(attenuated)vaccinesSubunit vaccinesGene engineered vaccineDNA vaccinesToxoid较高，较高，维持维持3535年甚至更长年甚至更长较低，较低，维持数月维持数月22年年免疫效果免疫效果不易保存，不易保存，44数周数周易易保存，约保存，约1 1年年保存及有效期保存及有效期量量较小，较小，1 1次次量量较大，较大，2323次次接种剂量与特点接种剂量与特点活减毒株活减毒株死，强毒株死，强毒株制剂特点制剂特点活活疫苗疫苗死死疫苗疫苗区别点区别点nAntitoxin:e.g.Tetanus anti

12、toxin and diphtheria antitoxin nAntiserumnSpecific immunoglobulinnCytokineu Artificial passive immunityninvolves giving both a vaccine to provide long-term protection(preventive infection)and immune globulin to provide immediate protection(therapeutic and preventive infectious disease).u Active-pass

13、ive immunityTreat or emergency prevebtionPreventionMain usageshort，23WLong,several years several monthsDurationFastslow，24WTime of responseAntibody,cytokineAntigensubstancePassive immunityAvtive immunityitms国家免疫规划疫苗国家免疫规划疫苗:20082008年年2 2月月 以前以前:乙肝疫苗、卡介苗、脊灰疫苗、百白破疫苗、麻乙肝疫苗、卡介苗、脊灰疫苗、百白破疫苗、麻 疹疫苗、白破疫苗疹疫苗、

14、白破疫苗08:08:甲肝疫苗、流脑疫苗、乙脑疫苗、麻风腮疫苗甲肝疫苗、流脑疫苗、乙脑疫苗、麻风腮疫苗重点人群和地区：重点人群和地区：出血热疫苗、炭疽疫苗、钩体疫苗出血热疫苗、炭疽疫苗、钩体疫苗预防的传染病预防的传染病1515种种:乙肝、结核、脊灰、百日咳、白喉、破伤风、麻乙肝、结核、脊灰、百日咳、白喉、破伤风、麻疹、甲肝、流脑、乙脑、风疹、腮腺炎、出血热、炭疹、甲肝、流脑、乙脑、风疹、腮腺炎、出血热、炭疽、钩体疽、钩体 Antimicrobial chemotherapynChemotherapy as a science began with Paul Ehrlich in the firs

15、t decade of the 20th century.nEhrlichs experiments led to the arsphenamines(胂凡纳明)for syphilis,the first planned chemotherapy.金葡菌菌血症的死亡率 Rubin RJ et al.Emerging Infect Dis 1999;5:9-17青霉素时代耐青霉素时代苯唑西林时代万古霉素时代抗生素前时代%近年来，世界抗生素市场的平均年增长率约为近年来，世界抗生素市场的平均年增长率约为8%8%，世界抗感染药物市场销售额为世界抗感染药物市场销售额为400400亿美元，约占全球亿美元

16、，约占全球治疗性药物市场的治疗性药物市场的10%10%。各类抗感染药具体销售情况是：各类抗感染药具体销售情况是：抗生素抗生素占世界抗占世界抗感染药物市场的最大份额感染药物市场的最大份额(约约250250亿亿260260亿美元亿美元)；抗抗病毒病毒药居第二位药居第二位(约约5555亿亿5656亿美元亿美元)；第三位为；第三位为抗真抗真菌菌药药(40(40亿亿4242亿美元亿美元)；其余则为疫苗和抗原生动物；其余则为疫苗和抗原生动物药等抗感染药小品种。药等抗感染药小品种。头孢菌素头孢菌素类在世界抗感染药物市场中占较大比类在世界抗感染药物市场中占较大比重，目前其销售额约占抗感染药销售额的重，目前其销

17、售额约占抗感染药销售额的40%40%，有，有的国家高于这一数值。在美国市场，头孢菌素的销的国家高于这一数值。在美国市场，头孢菌素的销售额占抗感染药销售额的售额占抗感染药销售额的45%45%。u Use principle of Antibioticp Appropriate drugsp Appropriate dosagep Alternate usep Drug combination思考题思考题1 1、根据已学知识，如何对细菌性感染患者提出、根据已学知识，如何对细菌性感染患者提出 微生物学的诊断方案？微生物学的诊断方案？2 2、简述细菌感染的特异性预防措施。、简述细菌感染的特异性预防措施。预习：预习：消毒灭菌与生物安全消毒灭菌与生物安全