Medical Microbiology
医学微生物学
Department of Microbiology, GMC
第10章 肠道传播的病原微生物
Department of Microbiology, Guangzhou Medical College
第10章 肠道传播的病原微生物
第7节 肠道感染病毒 Gastrointestine-Infected Viruses
Department of Microbiology, Guangzhou Medical College
教学大纲

掌握内容
肠道病毒种类及共同特性 脊髓灰质炎病毒主要生物学性状、致病性、
微生物学检查法及防治原则
柯萨奇病毒分组、分型及致病性

熟悉内容
埃可病毒、肠道病毒70型、肠道病毒71型的
根据对乳鼠致病性分为
B组：1~6型
（三）埃可病毒(ECHO virus)
1950s初，人肠道致细胞病变孤儿病毒。
(enteric cytopathogenic human orphan virus, ECHO virus)
1~34型(31)
Department of Microbiology, Guangzhou Medical College
Syndrome Polio Paralytic disease + Meningitis-encephalitis + Carditis + Neonatal disease Pleurodynia Herpangina Rash disease Haemorr. conjunctivitis Respiratory infections + Undifferentiated fever + Diabetes/pancreatitis Cox A + + + + + + + + + + + + Cox B + + + + + + + + Echo + + + + -
Department of Microbiology, Guangzhou Medical College



归属于小RNA病毒科（Picornaviridae） 实际上有67个血清型 人类肠道病毒包括：
脊髓灰质炎病毒（poliovirus）:1~3
柯萨奇病毒（coxsackievirus）:A组1~24(23)；
Astrovirus Enteric Adenvirus, EAdV
Department of Microbiology, Guangzhou Medical College
小结

肠道病毒种类及共同特性 脊髓灰质炎病毒主要生物学性状、致病 性、微生物学检查法及防治原则 柯萨奇病毒分组、分型及致病性
微生物学检查
病毒分离检查： 血清学检查： 双份血清 细胞培养 ELISA IFA 补体试验 PCR法
中和试验
Department of Microbiology, Guangzhou Medical College
防治原则
人工主动免疫 （注射死疫苗）
OPV,Sabin
IPV，Salk (1955.4.12)

Enterovirus 72
was
assigned to a new family called heptoviruses
Department of Microbiology, Guangzhou Medical College
Diseases associated with Enteroviruses
致病性
Department of Microbiology, Guangzhou Medical College
问题

肠道病毒有哪些？是不是肠道感染的所 有病毒都称为肠道病毒？ 简要说明肠道病毒的特性 脊髓灰质炎病毒的传播途径、致病机制 是什么？如何预防脊灰？ B组柯萨奇病毒的致病有何特点？ ECHO病毒、轮状病毒、杯状病毒、小 圆结构病毒分别与哪些疾病有关？
Echoviruses

The first echoviruses were accidentally discovered in 1951 during epidemiological studies of polioviruses.

CPE in cell cultures
Department of Microbiology, Guangzhou Medical College
免疫性

脊灰病毒部产生sIgA， 阻止病毒入血。血液中出现中和性IgG、 IgM抗体，阻止病毒进入神经系统。中和抗 体可长时间维持（终生）。
Department of Microbiology, Guangzhou Medical College
柯萨奇病毒与埃可病毒的形态结生物学特
性、致病性及免疫过程与脊髓灰质炎病毒 相似，粪口途径传播，进入机体后可侵犯 多种组织和细胞，临床表现多样化。如：
①无菌性脑膜炎 ②疱疹性咽颊炎 ③手足口病 ④流行性胸疼 ⑤心肌炎、心包炎 ⑥皮疹等 微生物学检查： 分离病毒；血清学诊断；PCR 防治原则：
Department of Microbiology, Guangzhou Medical College
(一)脊髓灰质炎病毒（Poliovirus）

First identified in 1909 by inoculation of specimens into monkeys First grown in cell culture in 1949 which became the basis for vaccines
Department of Microbiology, Guangzhou Medical College
Herpangina

Herpangina – usually coxackie A
acute
onset, fever, sore throat, dysphagia – posterior pharynx persist w’s
衣壳有VP1~VP4四种蛋白，VP1~VP3分布在表面 ，VP4与内部RNA结合。


耐酸、耐乙醚。但鼻病毒除外
在胞浆增殖，有明显CPE。

引起多种疾病（主要症状不在肠道）：
麻痹性疾病、无菌性脑膜炎、心肌炎、腹泻、
皮疹、手足口病等。
Department of Microbiology, Guangzhou Medical College

Hand-foot-and-mouth disease: mostly coxackie A

fever, malaise, sore throat, vesicles on bucal mucosa, tongue, hands, feet, buttocks

highly infectious resolution – 1w

90％的感染为隐性感染。


约5％出现流产感染。
1％～2％的患者，病毒可侵入CNS，引起 非麻痹性脊髓灰质炎或无菌性脑膜炎。 仅约0.1%出现永久性弛缓性肢体麻痹。


极少数发展为延髓麻痹。
Department of Microbiology, Guangzhou Medical College
Department of Microbiology, Guangzhou Medical College
lesions
can no
gingivitis
Department of Microbiology, Guangzhou Medical College
Laboratory Diagnosis

Virus Isolation Serology
Department of Microbiology, Guangzhou Medical College
via
hands and objects
via
food and water
Department of Microbiology, Guangzhou Medical College
致病机制
人类是唯一的易感宿主
粪－口途径传播
以上呼吸道、咽喉、 肠道为侵入门户
局部粘膜 和淋巴结 中增殖
粪便
增殖后形成第 二次病毒血症 及临床症状
Management and Prevention

There is no specific antiviral therapy available against enteroviruses other than polio.
IVIG HNIG


There is no vaccine
Department of Microbiology, Guangzhou Medical College
（口服减毒活疫苗） 优 类似自然感染途径 点 刺激肠道局部产生SIgA 产生间接免疫 人工被动免疫：易感者用丙种球蛋白
Department of Microbiology, Guangzhou Medical College
我国政府规定每年12月5日和
1月5日为脊灰疫苗日。
Department of Microbiology, Guangzhou Medical College
Exanthems - Rubelliform rashes