醫(yī)學(xué)教材 腸道病毒

第三篇醫(yī)學(xué)相關(guān)病毒腸道病毒Gastrointestine-InfectedViruses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)容埃可病毒、腸道病毒70型、腸道病毒71型的致病性問題腸道病毒有哪些？是不是腸道感染的所有病毒都稱為腸道病毒？簡要說明腸道病毒的特性脊髓灰質(zhì)炎病毒的傳播途徑、致病機(jī)制是什么？如何預(yù)防脊灰？B組柯薩奇病毒的致病有何特點(diǎn)？ECHO病毒、輪狀病毒、杯狀病毒、小圓結(jié)構(gòu)病毒分別與哪些疾病有關(guān)？GroupsandSerotypesPicornaviridae（小RNA病毒科）Atleast71serotypes,dividedinto4subgroupsPolioviruses（脊髓灰質(zhì)炎病毒）Coxsackieviruses（柯薩奇病毒）Echoviruses（埃可病毒）Newenteroviruses（新腸道病毒）morerecently,newenterovirusessubtypehavebeenallocatedsequentialnumbers(68-71))EnterovirusesSerotypesMorphology27nm,icosahedralsymmetry,noenvelopeEnterovirusstructureSurfacecleft–attachmenttocellularreceptors:Immunoglobulinsuperfamily,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–oralroute(糞－口途徑)viahandsandobjects viafoodandwaterThefirstwrittenrecordofvirusinfectionAheiroglyphfromMemphis,drawninapproximately1400BC,whichdepictsatemplepriestcalledSiptahshowingtypicalclinicalsignsofparalyticpoliomyelitisFranklinD.RooseveltInthesummerof1921,whenhewas39,disasterhit-hewasstrickenwithpoliomyelitis.Demonstratingindomitablecourage,hefoughttoregaintheuseofhislegs,particularlythroughswimming.ManifestationsMostinfectionsasymptomatic,95%Abortivepolio(minorillness),5%fever,malaise,sorethroat,myalgia,headacheAsepticmeningitis(nonparalyticpolio),1%Paralyticpolio(majorillness),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CurrentStatusofWildPoliovirusTransmission我國政府規(guī)定每年12月5日和1月5日為脊灰疫苗日。柯薩奇病毒（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-OralroutetrasmissionSpreadinthebodylikepoliovirusesDiseaseAssociationsParalyticDiseaseMeningitisEncephalitisUndifferentiatedfebrileillnessHandfootmouthdiseaseHerpanginaEpidemicPleurodynia(Bornholmdisease)Myocarditis

RespiratoryInfectionsRubelliformrashesNeonatalInfectionConjunctivitisPancreatitis/DiabetesExanthems-RubelliformrashesEVleadingcauseinsummer&fall.AlltypesofrashHand-foot-and-mouthdiseaseHand-foot-and-mouthdisease:mostlycoxackieAfever,malaise,sorethroat,vesiclesonbucalmucosa,tongue,hands,feet,buttockshighlyinfectiousresolution–1wHerpanginaHerpangina–usuallycoxackieAacuteonset,fever,sorethroat,dysphagia

lesions–posteriorpharynxcanpersistw’snogingivitisLaboratoryDiagnosisVirusIsolationSerologyManagementandPreventionThereisnospecificantiviraltherapyavailableagainstenterovirusesotherthanpolio.IVIGHNIGThereisnovaccineEchovirusesThefirstechoviruseswereaccidentallydiscoveredin1951duringepidemiologicalstudiesofpolioviruses.CPEincellculturesTypesThereare32echoviruses

NogroupAgPathogenesis主要導(dǎo)致無菌性腦炎、類脊髓灰質(zhì)炎等感染后對(duì)同型病毒可產(chǎn)生持久免疫診斷困難尚無疫苗預(yù)防以隔離為主DiseasesassociatedwithEnterovirusesNewEnteroviruses4newenteroviruses(68-72)Enterovirus71appearstobehighlypathogenicandhasbeenassociatedwithepidemicsofavarietyofacutediseasesEnterovirus72wasassignedtoanewfamilycalledheptoviruses腸道病毒70型

病毒存在于眼結(jié)膜接觸傳播引起急性出血性結(jié)膜炎（俗稱“紅眼病”）。本病起病急，潛伏其為1d,病程8~10d，主要侵犯眼結(jié)膜，引起結(jié)膜下出血，愈后良好。該病毒還具有一定的嗜神經(jīng)性，侵犯中樞神經(jīng)系統(tǒng)，出現(xiàn)腰骶脊神經(jīng)根炎，引起下肢麻痹。

腸道病毒71型小RNA病毒可在原代細(xì)胞中增殖，但敏感性差，能引起乳鼠病變。耐熱、耐酸，可抵抗70%的乙醇，高溫和紫外線照射很快可將其滅活。

感染多發(fā)于夏、秋，10歲以下兒童