肺炎鏈球菌課件

Chapter8球菌（coccus）pyogeniccocci化膿性球菌G+:Staphylococcus葡萄球菌、Streptococcus鏈球菌、enterococcus腸球菌G-:N.meningitidis

腦膜炎奈瑟菌，

N.gonorrhoeae

淋病奈瑟菌noflagellum,nospore

1.Chapter8球菌（coccus）pyogenic葡萄球菌屬（staphylococci）MorphologyTypicalOrganismsGrampositivespherical

cells革蘭陽性球菌grape-likeclusters葡萄串狀2.葡萄球菌屬（staphylococci）MorphologyculturegrowreadilyonmostmediaOrdinaryplate普通平板Bloodplate血平板Coloniesround,smoothraised,andglisteningformpigment色素goldenyellow金黃色whitelemonyellow檸檬黃有些菌溶血產(chǎn)生溶血環(huán)(hemolyticzones)3.culturegrowreadilyonmostmeBiochemistryreaction觸酶陽性多數(shù)菌分解葡萄糖、麥芽糖和蔗糖，產(chǎn)酸不產(chǎn)氣致病菌分解甘露醇

4.Biochemistryreaction觸酶陽性4.

Antigenicstructure抗原構(gòu)造capsulepolysaccharide(teichoicacid)SPA5.Antigenicstructure抗原構(gòu)造capsulSPA（staphylococcalproteinA）

ProteinAisasurfaceproteinofSaureuswhichbindsIgG1,IgG2,andIgG4moleculesbytheirFcregion.

FabFc本質(zhì)：單鏈多肽（細胞壁上與肽聚糖結(jié)合）90%以上的金葡菌有特性：與人和一些動物IgG1，IgG2，IgG4的FC段非特異性結(jié)合。意義：致病作用---與抗體結(jié)合后有抗吞噬，促細胞分裂、超敏反應(yīng)等作用。協(xié)同凝集試驗---利用含SPA的葡萄球菌作為載體，用于多種微生物抗原檢出。6.SPA（staphylococcalproteinA）

classificaion色素、生化反應(yīng)金黃色葡萄球菌（S.aureus）表皮葡萄球菌（S.epidermidis）腐生葡萄球菌（S.saprophyticus）有無凝固酶凝固酶陰性葡萄球菌（Coagulasepositivestaphylococcus)凝固酶陽性葡萄球菌（Coagulasenegativestaphylococcus)7.classificaion色素、生化反應(yīng)7.

金黃色葡萄球菌表皮葡萄球菌腐生葡萄球菌pigment色素金黃色白色白色或檸檬色fermentmannitol發(fā)酵甘露醇+--coagulase凝固酶+--αhemolysins溶素+--thermostabledeoxyribonuclease耐熱核酸酶+--SPA+--Pathogenicity致病性+-（致病性葡萄球菌的鑒別）8.

金黃色表皮腐生pigment色素金黃色白色白色或檸檬色feResistance抵抗力

Theirresistanceisstrongestamongnonspore-formingbacteria對外界因素的抵抗力強于其他無芽孢菌sensitivetoalkalidyes對堿性染料敏感（龍膽紫）drug-resistance耐藥性MRSA9.Resistance抵抗力

TheirresistancePathogenesis&Immunity

VirulenceFactors致病物質(zhì)表面結(jié)構(gòu)Enzymes酶

Coagulase血漿凝固酶thermostabledeoxyribonuclease耐熱核酸酶Toxins毒素staphylolysin葡萄球菌溶素leukocidin殺白細胞素Toxicshocksyndrometoxin-1毒性休克綜合征毒素-1Enterotoxins(AtoE)腸毒素Exfoliativetoxin表皮剝脫毒素10.Pathogenesis&Immunity

Virulecoagulase凝固酶概念使含有抗凝劑的人或兔血漿發(fā)生凝固的酶類物質(zhì)游離凝固酶freecoagulase結(jié)合凝固酶boundcoagulase意義鑒別有無致病性的重要指標致病機理：抵抗吞噬細胞的吞噬保護病菌不受血清中殺菌物質(zhì)的破壞感染局限化和形成血栓11.coagulase凝固酶概念11.表皮剝脫毒素（exfoliativetoxin）引起機體發(fā)熱，增加對內(nèi)毒素的敏感性可引起多個器官系統(tǒng)的功能紊亂或毒性休克綜合征（TSS）引起燙傷樣皮膚綜合征（staphylococcalscaldedskinsyndrome，SSSS）毒性休克綜合征毒素-1（TSST-1）12.表皮剝脫毒素（exfoliativetoxin）引起機體發(fā)腸毒素（enterotoxin）約1/3臨床分離金黃色葡萄球菌可產(chǎn)生引起急性胃腸炎，即食物中毒heat-stable(resistboilingfor30’)耐熱resistanttotheactionofgutenzymes抗胃腸液中蛋白酶作用機制：刺激嘔吐中樞導致以惡心嘔吐（

nauseaandvomiting）為主要癥狀的食物中毒13.腸毒素（enterotoxin）約1/3臨床分離金黃色葡萄球

Clinicalfindings

：

Invasive侵襲性disease(suppurativeinflammation化膿性炎癥)Localinfection局部感染boil癤，carbuncle癰，bronchitis支氣管炎，pneumonia，meningitisSystematicinfections全身感染Septicemia敗血癥,pyemia膿毒血癥

Toxinosis毒素性疾病Foodpoisoning食物中毒Staphylococcalscaldedskinsyndrome(SSSS)燙傷樣皮膚綜合征Toxicshocksyndrome毒性休克綜合征Pseudomembranouscolitis假膜性腸炎14.

Clinicalfindings：Coagulase-negativeStaphylococcusspecies

凝固酶陰性葡萄球菌CNSUrinarytractinfection泌尿系統(tǒng)感染septicemiaopportunisticinfections15.Coagulase-negativeStaphylococImmunity

人類有一定的天然免疫力感染后能獲得一定的免疫力，但不強16.Immunity

人類有一定的天然免疫力16.ELISA小貓試驗DiagnosticLaboratoryTests微生物檢查法標本膿汁，血液，剩余食物，嘔吐物等分離培養(yǎng)血漿凝固酶發(fā)酵甘露醇耐熱核酸酶直接涂片鏡檢革蘭陽性葡萄串狀球菌生長現(xiàn)象色素，溶血生化反應(yīng)毒素檢查17.ELISADiagnosticLaboratoryTesPrevention&Treatment防治防注意消毒隔離注意個人衛(wèi)生防止醫(yī)源性感染防止耐藥性產(chǎn)生治抗生素藥敏試驗自身菌苗療法18.Prevention&Treatment防治防Streptococci鏈球菌屬Grampositivesphericalorovoidcells,arrangedinchainsordiplococci雙球菌lancet-shaped矛頭狀：平面相對尖面相背Streptococcuspneumoniae(pneumococcus)

肺炎鏈球菌（肺炎球菌）19.Streptococci鏈球菌屬GrampositiveCulture培養(yǎng)特性：growthrequiresbloodLiquidmedium:sedimentinbottom液體培養(yǎng)為沉淀生長血平板呈灰白色表面光滑小菌落，一些菌株產(chǎn)生溶血素（不同菌株溶血不一）肺炎鏈球菌:autolysin自溶酶20.Culture培養(yǎng)特性：growthrequiresbl生化反應(yīng)分解葡萄糖除肺炎鏈球菌外，不分解菊糖，不被膽汁溶解（鑒別甲型溶血性鏈球菌與肺炎鏈球菌）21.生化反應(yīng)分解葡萄糖21.Ⅰ.Antigenicstructure抗原構(gòu)造多糖抗原（C抗原）表面蛋白抗原型特異性M、T、R、S核蛋白抗原S.pneumoniae莢膜多糖抗原Thecapsularpolysaccharideisimmunologicallydistinctforeachofthemorethan85types.根據(jù)莢膜多糖抗原不同，至少可分為85個型別。分20個群，A群致病菌(溶血性鏈球菌或化膿性鏈球菌）classification分類根據(jù)蛋白抗原進一步分型22.Ⅰ.Antigenicstructure抗原構(gòu)造多糖抗原（Ⅱ.Hemolysisonbloodagar根據(jù)溶血現(xiàn)象分類apartialor"green"hemolysis草綠色溶血-Hemolysis-hemolyticstreptococcus甲型溶血性鏈球菌Opportunisticpathogencompletelysis完全溶血

-hemolysis-hemolyticstreptococcus乙型溶血性鏈球菌pathogenNonhemolytic不溶血γ-hemolysisγ-streptococcus丙型鏈球菌Non-pathogen23.Ⅱ.Hemolysisonbloodagar根據(jù)溶血現(xiàn)Pathogenesis致病性GroupAStreptococcusVirulenceFactors致病物質(zhì)StructuralComponents結(jié)構(gòu)成分：

Mprotein，F(xiàn)protein，LTA脂磷壁酸Enzymes酶：Hyaluronidase透明質(zhì)酸酶Streptodornase鏈道酶Strpetokinase鏈激酶Collagenase膠原酶Toxins毒素Pyrogenicexotoxins:致熱外毒素StreptolysinO、S鏈球菌溶素O、S24.Pathogenesis致病性GroupAStrepF蛋白（proteinF）Itmediatesadherence粘附toepithelialcells上皮細胞有抗吞噬和抗吞噬細胞內(nèi)殺菌作用與某些超敏反應(yīng)疾病有關(guān),rheumaticfever風濕熱M蛋白25.F蛋白（proteinF）ItmediatesadheHyaluronidase透明質(zhì)酸酶spreadingfactor擴散因子splitshyaluronicacid透明質(zhì)酸→spreading擴散鏈激酶（streptokinase；SK）

鏈道酶（streptodornase；SD）26.Hyaluronidase透明質(zhì)酸酶spreadingfa鏈球菌溶素（streptolysin）SLO：Itisrapidlyinactivatedinthepresenceofoxygen.對O2敏感。Anantibody,antistreptolysinO,appearsinhumanfollowinginfectionwithanystreptococcithatproducestreptolysinO.感染產(chǎn)生鏈球菌溶素O的鏈球菌后出現(xiàn)抗鏈球菌溶素O抗體。測定SLO抗體含量，可作為鏈球菌新近感染指標之一或風濕熱及其活動性的輔助診斷SLS：Itisoxygen-stable.對O2穩(wěn)定hemolyticzones溶血環(huán)27.鏈球菌溶素（streptolysin）SLO：27.致熱外毒素（pyrogenicexotoxin，SPE）Erythrogenictoxin紅疹毒素，scarletfevertoxin猩紅熱毒素A群鏈球菌溶原菌菌株產(chǎn)生scarletfever猩紅熱28.致熱外毒素（pyrogenicexotoxin，SPE）EClinicalfindings所致疾?。篏roupAStreptococcus

A群鏈球菌

lymphangitis淋巴管炎scarletfever猩紅熱Poststreptococcalallergicdiseases超敏反應(yīng)性疾病Pyogenicinfection化膿性感染Toxicdisease中毒性疾病cellulites蜂窩組織炎nasosinusitis鼻竇炎tonsillitis扁桃體炎

rheumaticfever風濕熱acuteglomerulonephritis急性腎小球腎炎29.Clinicalfindings所致疾?。篏roupVirulencefactors致病物質(zhì)：

S.pneumoniaecapsule莢膜Pathology所致疾?。篖obarpneumonia

大葉性肺炎30.VirulencefactorsS.pneumoniaSreptococcusviridans草綠色鏈球菌（α-hemolyticstreptococcus）甲型鏈球菌subacutebacterialendocarditis亞急性細菌性心內(nèi)膜炎dentalcaries齲齒Neonatalinfections(meningitis,pneumonia,bacteremia)新生兒感染（腦膜炎、肺炎、菌血癥）GroupBstreptococcus/GBSB群鏈球菌(Sreptococcusagalacitae無乳鏈球菌)31.Sreptococcusviridans草綠色鏈球菌suimmunity免疫性可刺激機體產(chǎn)生各種抗體抗M蛋白抗體有保護作用型別間無交叉免疫猩紅熱患者可建立牢固的同型抗毒素免疫肺炎鏈球菌建立同型免疫，產(chǎn)生型特異的莢膜多糖抗體32.immunity免疫性可刺激機體產(chǎn)生各種抗體肺炎鏈球菌32.DiagnosticLaboratoryTests微生物學檢查法標本直接涂片鏡檢革蘭陽性鏈球菌分離培養(yǎng)膿汁，血液，咽喉拭子甲型鏈球菌與肺炎鏈球菌的鑒別菊糖分解試驗膽汁溶菌試驗Optochin敏感試驗動物試驗33.DiagnosticLaboratoryTests微生物血清學檢查抗鏈球菌溶素O試驗：抗O試驗（ASOtest）34.血清學檢查抗鏈球菌溶素O試驗：抗O試驗（ASOtest）3Prevention&Treatment積極治療兒童鏈球菌感染肺炎鏈球菌：capsularpolysaccharidesvaccine莢膜多糖疫苗選用青霉素35.Prevention&Treatment35.Neisseria奈瑟菌屬Gramnegative，aerobic

diplococci革蘭陰性需氧雙球菌N.gonorrhoeaeandN.meningitidis淋病奈瑟菌和腦膜炎奈瑟菌36.Neisseria奈瑟菌屬GramnegativeN.meningitidis（meningococcus)

腦膜炎奈瑟菌kidney-shaped腎形37.N.meningitidis（meningococcus)Culture

aerobicbacteria專性需氧菌5～8％CO2enrichedmedia：heatedbloodagar(“chocolate”agar)

巧克力（色）培養(yǎng)基autolysin

38.Cultureaerobicbacteria專性需氧菌3AntigenicStructure抗原構(gòu)造groupedonthebasisoftheircapsularpolysaccharides莢膜多糖群特異性抗原分群ThemostimportantserogroupsassociatedwithdiseaseinhumanareA,B,C,Y,andw-135Resistance抵抗力veryweak很弱四怕熱寒冷干燥消毒劑39.AntigenicStructure抗原構(gòu)造groupedPathogenesis致病性Pathogenicsubstances致病物質(zhì):capsule,piliandLOS莢膜、菌毛、脂寡糖Pathology所致疾病meningitis流行性腦脊髓膜炎Thenasopharynx鼻咽istheportalofentry.

Symptom：intenseheadache,vomiting,stiffneck,andcoma頭痛、嘔吐、頸部強直、昏迷三種臨床類型

普通型、爆發(fā)型、慢性敗血癥型40.Pathogenesis致病性PathogenicsubImmunity：antibodiesintheserum血清中的抗體41.Immunity：antibodiesintheserDiagnosticLaboratoryTests微生物學檢查Specimens標本culture培養(yǎng)blood,spinalfluid腦脊液,andpuncturematerialfrompetechiae淤斑滲出液、nasopharyngealswab鼻咽拭保暖、保濕、立即送檢，培養(yǎng)基預溫Smears直接涂片鏡檢typicalneisseriaewithinpolymorphonuclearleukocytesorextracellilarly中性粒細胞內(nèi)、外有革蘭陰性雙球菌heatedbloodagar(“chocolate”agar)巧克力（色）培養(yǎng)基Rapiddignose快速診斷counterimmunoelectrophoresis對流免疫電泳SPAcoagglutination

SPA協(xié)同凝集試驗42.DiagnosticLaboratoryTests微生物

Prevention&Treatment防治原則children

capsularpolysaccharidevaccines

莢膜多糖疫苗

Treatment

Penicillin43.Prevention&Treatment防治原則cN.gonorrhoeae(gonococcus)淋病奈瑟菌Bean－shaped，usuallyseeninpairswithadjacentflattenedsides.平面相對，成對排列44.N.gonorrhoeae(gonococcus)淋pili菌毛outermembranousprotein外膜蛋白（PI,PII,PIII)LOSIgA1proteinase

IgA1蛋白酶gonorrhea淋病Humansaretheonlynaturalhost.Transmissionisviasexualcontact人類是淋病奈瑟菌的唯一宿主。主要通過性接觸引起泌尿道和生殖系統(tǒng)炎癥gonococcalophthalmianeonatorum新生兒淋菌性結(jié)膜炎throughbirthcanal通過產(chǎn)道感染致病物質(zhì)Pathogenesis所致疾病45.pili菌毛gonorrhea淋病HumansarethRepeatedgonococcalinfectionsarecommon.Immunity46.RepeatedgonococcalinfectionsDiagnosticLaboratoryTests微生物學檢查Specimens標本culture培養(yǎng)pusandsecretionsaretakenfromtheurethra,cervix尿道、宮頸等的膿汁和分泌物保暖、保濕、立即送檢，培養(yǎng)基預溫Smears直接涂片鏡檢typicalneisseriaewithinpolymorphonuclearleukocytes中性粒細胞內(nèi)有革蘭陰性雙球菌heatedbloodagar(“chocolate”agar)巧克力（色）培養(yǎng)基47.DiagnosticLaboratoryTests微生物防治原則防開展防治性病的知識教育防止不正當?shù)膬尚躁P(guān)系治抗生素

1%silvernitrateintheeyesofnewbornbabies新生兒1%硝酸銀滴眼。48.防治原則防開展防治性病的知識教育防止不正當?shù)膬尚躁P(guān)系治抗生素Chapter8球菌（coccus）pyogeniccocci化膿性球菌G+:Staphylococcus葡萄球菌、Streptococcus鏈球菌、enterococcus腸球菌G-:N.meningitidis

腦膜炎奈瑟菌，

N.gonorrhoeae

淋病奈瑟菌noflagellum,nospore

49.Chapter8球菌（coccus）pyogenic葡萄球菌屬（staphylococci）MorphologyTypicalOrganismsGrampositivespherical

cells革蘭陽性球菌grape-likeclusters葡萄串狀50.葡萄球菌屬（staphylococci）MorphologyculturegrowreadilyonmostmediaOrdinaryplate普通平板Bloodplate血平板Coloniesround,smoothraised,andglisteningformpigment色素goldenyellow金黃色whitelemonyellow檸檬黃有些菌溶血產(chǎn)生溶血環(huán)(hemolyticzones)51.culturegrowreadilyonmostmeBiochemistryreaction觸酶陽性多數(shù)菌分解葡萄糖、麥芽糖和蔗糖，產(chǎn)酸不產(chǎn)氣致病菌分解甘露醇

52.Biochemistryreaction觸酶陽性4.

Antigenicstructure抗原構(gòu)造capsulepolysaccharide(teichoicacid)SPA53.Antigenicstructure抗原構(gòu)造capsulSPA（staphylococcalproteinA）

ProteinAisasurfaceproteinofSaureuswhichbindsIgG1,IgG2,andIgG4moleculesbytheirFcregion.

FabFc本質(zhì)：單鏈多肽（細胞壁上與肽聚糖結(jié)合）90%以上的金葡菌有特性：與人和一些動物IgG1，IgG2，IgG4的FC段非特異性結(jié)合。意義：致病作用---與抗體結(jié)合后有抗吞噬，促細胞分裂、超敏反應(yīng)等作用。協(xié)同凝集試驗---利用含SPA的葡萄球菌作為載體，用于多種微生物抗原檢出。54.SPA（staphylococcalproteinA）

classificaion色素、生化反應(yīng)金黃色葡萄球菌（S.aureus）表皮葡萄球菌（S.epidermidis）腐生葡萄球菌（S.saprophyticus）有無凝固酶凝固酶陰性葡萄球菌（Coagulasepositivestaphylococcus)凝固酶陽性葡萄球菌（Coagulasenegativestaphylococcus)55.classificaion色素、生化反應(yīng)7.

金黃色葡萄球菌表皮葡萄球菌腐生葡萄球菌pigment色素金黃色白色白色或檸檬色fermentmannitol發(fā)酵甘露醇+--coagulase凝固酶+--αhemolysins溶素+--thermostabledeoxyribonuclease耐熱核酸酶+--SPA+--Pathogenicity致病性+-（致病性葡萄球菌的鑒別）56.

金黃色表皮腐生pigment色素金黃色白色白色或檸檬色feResistance抵抗力

Theirresistanceisstrongestamongnonspore-formingbacteria對外界因素的抵抗力強于其他無芽孢菌sensitivetoalkalidyes對堿性染料敏感（龍膽紫）drug-resistance耐藥性MRSA57.Resistance抵抗力

TheirresistancePathogenesis&Immunity

VirulenceFactors致病物質(zhì)表面結(jié)構(gòu)Enzymes酶

Coagulase血漿凝固酶thermostabledeoxyribonuclease耐熱核酸酶Toxins毒素staphylolysin葡萄球菌溶素leukocidin殺白細胞素Toxicshocksyndrometoxin-1毒性休克綜合征毒素-1Enterotoxins(AtoE)腸毒素Exfoliativetoxin表皮剝脫毒素58.Pathogenesis&Immunity

Virulecoagulase凝固酶概念使含有抗凝劑的人或兔血漿發(fā)生凝固的酶類物質(zhì)游離凝固酶freecoagulase結(jié)合凝固酶boundcoagulase意義鑒別有無致病性的重要指標致病機理：抵抗吞噬細胞的吞噬保護病菌不受血清中殺菌物質(zhì)的破壞感染局限化和形成血栓59.coagulase凝固酶概念11.表皮剝脫毒素（exfoliativetoxin）引起機體發(fā)熱，增加對內(nèi)毒素的敏感性可引起多個器官系統(tǒng)的功能紊亂或毒性休克綜合征（TSS）引起燙傷樣皮膚綜合征（staphylococcalscaldedskinsyndrome，SSSS）毒性休克綜合征毒素-1（TSST-1）60.表皮剝脫毒素（exfoliativetoxin）引起機體發(fā)腸毒素（enterotoxin）約1/3臨床分離金黃色葡萄球菌可產(chǎn)生引起急性胃腸炎，即食物中毒heat-stable(resistboilingfor30’)耐熱resistanttotheactionofgutenzymes抗胃腸液中蛋白酶作用機制：刺激嘔吐中樞導致以惡心嘔吐（

nauseaandvomiting）為主要癥狀的食物中毒61.腸毒素（enterotoxin）約1/3臨床分離金黃色葡萄球

Clinicalfindings

：

Invasive侵襲性disease(suppurativeinflammation化膿性炎癥)Localinfection局部感染boil癤，carbuncle癰，bronchitis支氣管炎，pneumonia，meningitisSystematicinfections全身感染Septicemia敗血癥,pyemia膿毒血癥

Toxinosis毒素性疾病Foodpoisoning食物中毒Staphylococcalscaldedskinsyndrome(SSSS)燙傷樣皮膚綜合征Toxicshocksyndrome毒性休克綜合征Pseudomembranouscolitis假膜性腸炎62.

Clinicalfindings：Coagulase-negativeStaphylococcusspecies

凝固酶陰性葡萄球菌CNSUrinarytractinfection泌尿系統(tǒng)感染septicemiaopportunisticinfections63.Coagulase-negativeStaphylococImmunity

人類有一定的天然免疫力感染后能獲得一定的免疫力，但不強64.Immunity

人類有一定的天然免疫力16.ELISA小貓試驗DiagnosticLaboratoryTests微生物檢查法標本膿汁，血液，剩余食物，嘔吐物等分離培養(yǎng)血漿凝固酶發(fā)酵甘露醇耐熱核酸酶直接涂片鏡檢革蘭陽性葡萄串狀球菌生長現(xiàn)象色素，溶血生化反應(yīng)毒素檢查65.ELISADiagnosticLaboratoryTesPrevention&Treatment防治防注意消毒隔離注意個人衛(wèi)生防止醫(yī)源性感染防止耐藥性產(chǎn)生治抗生素藥敏試驗自身菌苗療法66.Prevention&Treatment防治防Streptococci鏈球菌屬Grampositivesphericalorovoidcells,arrangedinchainsordiplococci雙球菌lancet-shaped矛頭狀：平面相對尖面相背Streptococcuspneumoniae(pneumococcus)

肺炎鏈球菌（肺炎球菌）67.Streptococci鏈球菌屬GrampositiveCulture培養(yǎng)特性：growthrequiresbloodLiquidmedium:sedimentinbottom液體培養(yǎng)為沉淀生長血平板呈灰白色表面光滑小菌落，一些菌株產(chǎn)生溶血素（不同菌株溶血不一）肺炎鏈球菌:autolysin自溶酶68.Culture培養(yǎng)特性：growthrequiresbl生化反應(yīng)分解葡萄糖除肺炎鏈球菌外，不分解菊糖，不被膽汁溶解（鑒別甲型溶血性鏈球菌與肺炎鏈球菌）69.生化反應(yīng)分解葡萄糖21.Ⅰ.Antigenicstructure抗原構(gòu)造多糖抗原（C抗原）表面蛋白抗原型特異性M、T、R、S核蛋白抗原S.pneumoniae莢膜多糖抗原Thecapsularpolysaccharideisimmunologicallydistinctforeachofthemorethan85types.根據(jù)莢膜多糖抗原不同，至少可分為85個型別。分20個群，A群致病菌(溶血性鏈球菌或化膿性鏈球菌）classification分類根據(jù)蛋白抗原進一步分型70.Ⅰ.Antigenicstructure抗原構(gòu)造多糖抗原（Ⅱ.Hemolysisonbloodagar根據(jù)溶血現(xiàn)象分類apartialor"green"hemolysis草綠色溶血-Hemolysis-hemolyticstreptococcus甲型溶血性鏈球菌Opportunisticpathogencompletelysis完全溶血

-hemolysis-hemolyticstreptococcus乙型溶血性鏈球菌pathogenNonhemolytic不溶血γ-hemolysisγ-streptococcus丙型鏈球菌Non-pathogen71.Ⅱ.Hemolysisonbloodagar根據(jù)溶血現(xiàn)Pathogenesis致病性GroupAStreptococcusVirulenceFactors致病物質(zhì)StructuralComponents結(jié)構(gòu)成分：

Mprotein，F(xiàn)protein，LTA脂磷壁酸Enzymes酶：Hyaluronidase透明質(zhì)酸酶Streptodornase鏈道酶Strpetokinase鏈激酶Collagenase膠原酶Toxins毒素Pyrogenicexotoxins:致熱外毒素StreptolysinO、S鏈球菌溶素O、S72.Pathogenesis致病性GroupAStrepF蛋白（proteinF）Itmediatesadherence粘附toepithelialcells上皮細胞有抗吞噬和抗吞噬細胞內(nèi)殺菌作用與某些超敏反應(yīng)疾病有關(guān),rheumaticfever風濕熱M蛋白73.F蛋白（proteinF）ItmediatesadheHyaluronidase透明質(zhì)酸酶spreadingfactor擴散因子splitshyaluronicacid透明質(zhì)酸→spreading擴散鏈激酶（streptokinase；SK）

鏈道酶（streptodornase；SD）74.Hyaluronidase透明質(zhì)酸酶spreadingfa鏈球菌溶素（streptolysin）SLO：Itisrapidlyinactivatedinthepresenceofoxygen.對O2敏感。Anantibody,antistreptolysinO,appearsinhumanfollowinginfectionwithanystreptococcithatproducestreptolysinO.感染產(chǎn)生鏈球菌溶素O的鏈球菌后出現(xiàn)抗鏈球菌溶素O抗體。測定SLO抗體含量，可作為鏈球菌新近感染指標之一或風濕熱及其活動性的輔助診斷SLS：Itisoxygen-stable.對O2穩(wěn)定hemolyticzones溶血環(huán)75.鏈球菌溶素（streptolysin）SLO：27.致熱外毒素（pyrogenicexotoxin，SPE）Erythrogenictoxin紅疹毒素，scarletfevertoxin猩紅熱毒素A群鏈球菌溶原菌菌株產(chǎn)生scarletfever猩紅熱76.致熱外毒素（pyrogenicexotoxin，SPE）EClinicalfindings所致疾病：GroupAStreptococcus

A群鏈球菌

lymphangitis淋巴管炎scarletfever猩紅熱Poststreptococcalallergicdiseases超敏反應(yīng)性疾病Pyogenicinfection化膿性感染Toxicdisease中毒性疾病cellulites蜂窩組織炎nasosinusitis鼻竇炎tonsillitis扁桃體炎

rheumaticfever風濕熱acuteglomerulonephritis急性腎小球腎炎77.Clinicalfindings所致疾?。篏roupVirulencefactors致病物質(zhì)：

S.pneumoniaecapsule莢膜Pathology所致疾?。篖obarpneumonia

大葉性肺炎78.VirulencefactorsS.pneumoniaSreptococcusviridans草綠色鏈球菌（α-hemolyticstreptococcus）甲型鏈球菌subacutebacterialendocarditis亞急性細菌性心內(nèi)膜炎dentalcaries齲齒Neonatalinfections(meningitis,pneumonia,bacteremia)新生兒感染（腦膜炎、肺炎、菌血癥）GroupBstreptococcus/GBSB群鏈球菌(Sreptococcusagalacitae無乳鏈球菌)79.Sreptococcusviridans草綠色鏈球菌suimmunity免疫性可刺激機體產(chǎn)生各種抗體抗M蛋白抗體有保護作用型別間無交叉免疫猩紅熱患者可建立牢固的同型抗毒素免疫肺炎鏈球菌建立同型免疫，產(chǎn)生型特異的莢膜多糖抗體80.immunity免疫性可刺激機體產(chǎn)生各種抗體肺炎鏈球菌32.DiagnosticLaboratoryTests微生物學檢查法標本直接涂片鏡檢革蘭陽性鏈球菌分離培養(yǎng)膿汁，血液，咽喉拭子甲型鏈球菌與肺炎鏈球菌的鑒別菊糖分解試驗膽汁溶菌試驗Optochin敏感試驗動物試驗81.DiagnosticLaboratoryTests微生物血清學檢查抗鏈球菌溶素O試驗：抗O試驗（ASOtest）82.血清學檢查抗鏈球菌溶素O試驗：抗O試驗（ASOtest）3Prevention&Treatment積極治療兒童鏈球菌感染肺炎鏈球菌：capsularpolysaccharidesvaccine莢膜多糖疫苗選用青霉素83.Prevention&Treatment35.Neisseria奈瑟菌屬Gramnegative，aerobic

diplococci革蘭陰性需氧雙球菌N.gonorrhoeaeandN.meningitidis淋病奈瑟菌和腦膜炎奈瑟菌84.Neisseria奈瑟菌屬GramnegativeN.meningitidis（meningococcus)

腦膜炎奈瑟菌kidney-shaped腎形85.N.meningitidis（meningococcus)Culture

aerobicbacteria專性需氧菌5～8％CO2enrichedmedia：heatedbloodagar(“chocolate”agar)

巧克力（色）培養(yǎng)基autolysin

86.Cultureaerobicbacteria專性需氧菌3AntigenicStructure抗原構(gòu)造groupedonthebasisoftheircapsularpolysaccharides莢膜多糖群特異性抗原分群ThemostimportantserogroupsassociatedwithdiseaseinhumanareA,B,C,Y,andw-135Resistance抵抗力veryweak很弱四怕熱寒冷干燥消毒劑87.AntigenicStructure抗原構(gòu)造groupedPathogenesis致病性Pathogenicsubstances