宫内感染的病原学诊断ppt课件

1、CMV宫内感染的研讨现状.先天性感染新生儿感染也称为先天性感染congenital infection) ，主要包括宫内感染、产程感染和产后感染，其中宫内感染预后严重。其病原体主要包括：细菌，如李氏杆菌、军团菌、结核菌；寄生虫，如弓形虫Toxoplasma, TOX；病毒： 风疹 (Rubella virus, RUV), 巨细胞病毒(Cytomegilic virus, CMV), 单纯疱疹病毒(Herpessimplex virus, HSV) 乙型肝炎 HBV爱滋病 HIV-1其他病原体，如衣原体、支原体、梅毒；等所致的感染在新生儿期均有共同特点，故国外简称TORCH 综合症。.“T代表

2、弓形虫Toxoplasma “O代表其他柯萨其病毒，衣原体等Other “R代表风疹病毒Rubella ViruS “C代表巨细胞病毒Cytomegalo ViruS “H代表单纯疱疹病毒HerpesStmplex Virus， ToRCH 综合症一组优生优育挑选常用检测对象TORCH综合症：是指可导致先天性宫内感染及围产期感染而引起围产儿畸形的病原体，它是一组病原微生物的英文称号缩写： .宫内感染的途径宫内感染有以下几种途径：病原体由母体血运经胎盘而进入胎儿血循环中，或因胎盘炎症进入羊水中。病原体经阴道、宫颈上行性感染。胎膜已破者病原体可直接进入羊水；假设未破，那么可经胎膜或蜕膜而污染羊水。

3、病原体经输卵管下行性感染，由于绒毛膜、羊膜炎或蜕膜炎进入羊水。胎儿感染可由胎儿吞咽羊水至胃肠道内或吸入呼吸道内而感染。.宫内感染的发病机制1. 受孕前感染：病原体在孕前即进入卵细胞或精子，受精时产生先天转录 其病原体转入受精卵，使胚胎发育受阻。2. 着床前感染：病原体依赖于生殖细胞进展增殖，导致胚胎畸变，残疾或流产。3. 着床后感染：感染发生于妊娠1-3个月，导致重要器官系统发育缺陷。.宫内感染严重性的影响要素1. 病原体的数量与毒力2. 母体的免疫形状：初感时宿主免疫低下，感染后长期埋伏于体内，当宿主免疫力再度下降病原体激活 增殖再染 受感染器官系统损害加重。3. 胎儿成熟度。.巨细胞病毒

4、(cytomegalovirus, CMV ) .巨细胞病毒构造模拟图.CMV感染的根本特征CMV infects not only the fibroblasts, but also the majority of body cells.The immune response is focused on two human-CMV proteins, the envelope glycoprotein gB and the phosphoprotein pp65.The virus lacks the enzyme thymidine kinase, therefore it is resi

5、stant to antiviral agents that use this enzyme for their action.Receptor: GEF-Receptor and alpha V integrin; .CMV infects 60% of women of childbearing age in developed countries and 90% in developing countries (Griffiths, P.D. 2002).CMV Infection leaves the patients without symptoms and CMV establis

6、hes latency, except for cases where the hosts immune systemis compromised (AIDS, transplant patients and fetuses).congenital CMV infection can lead to sensorineural hearing loss, mental retardation, and neurologic deficits.CMV感染的流行病学.CMV感染对胎婴儿生长发育的影响一近期影响：流产、死胎、新生儿死亡，死亡率50%80%；二远期：5%出现发育异常. 表1 PCR检测

7、27例畸形及死亡新生儿CMV感染的脏器分布 脏器 受检数 阳性数 阳性率% 胸腺 11 6 54.6 脑 13 7 53.9 肝 26 13 50.0 肺 26 6 23.1 脾 15 3 20.0 肾 25 7 28.0 心 25 2 8.0 淋巴腺 1 0 0 唾液腺 1 1 1/1 合 计 141 45 31.91 .CMV的传播途径血行传播：输注血液或血制品 母-婴间垂直传播 脏器或组织移植唾液腺传播：人-人，程度传播乳汁传播：哺乳期传播精液传播：性接触传播.Mother-to-child transmission is mainly the result of primary mat

8、ernal CMV infection which carries a risk of transmission varying from 24% to 75% (mean value 40%) ; Cases of CMV transmission due to non-primary infection have been reported in 12.2% of cases, i.e. at a much lower rate than those resulting from primary infection; (Fowler et al., 1992 CMV的母-婴传播途径.孕妇C

9、MV 感染的诊断；胎儿CMV 宫内感染的诊断；CMV 宫内感染的诊断.1、病原学诊断：目前从血、分泌物、体液等标本中分别培育出病毒仍是诊断HCMV 感染的金规范。 PCR法； 病毒培育法; 2、孕妇血清抗体程度的检测；血清CMV特异性抗体的亚类鉴定；IgG与IgM血清抗体的亲和力测定；孕妇CMV 感染的诊断.CMV特异性细胞免疫功能测定.胎儿超声学检查：胎儿CMV 感染后可有超声学异常表现,如胎儿生长受限、脑室肿大、腹水、颅内钙化和羊水量异常(通常为羊水过少) 等；羊膜腔穿刺：CMV 宫内感染时,病毒常可累及胎儿肾脏并在其中复制,含有CMV 的零落细胞可随胎儿尿液进入羊水中,故羊水中检出CMV

10、 或其基因片段；脐静脉穿刺：孕20 周后可在超声引导下行脐静脉穿刺，所得胎血除可做病原体分别、基因扩增、特异性IgM抗体检测外,还可进展病毒定量和其它非特异目的的分析,包括血红蛋白、血小板、嗜酸性细胞数等血液学目的、转氨酶等生化目的；胎儿CMV 宫内感染的诊断.固相膜免疫检测.CMV的防治现状-Vaccine; Vaccine; Active vaccines have included live attenuated virus, killed virus vaccine, and recombinant vaccines；There are currently twoCMVvaccines

11、 in phase II studies.One is the CMV gB/MF59 vaccine which is disulfide-linked glycoprotein complex (gB) with 130 and 55 kDa components；The other vaccine in human trials is the Towne strain. It is a live attenuated vaccine used extensively in clinical trials and is safe；.Passive Immunization during P

12、regnancy for Congenital Cytomegalovirus Infection;Passive immunization which includes both hyperimmune sera and sera raised against the gB glycoprotein ofgpCMV has also been effective at reducing pup mortality and/or preventing congenital infection；CMV的防治现状-被动免疫治疗; .The end.CMV引起的细胞病变.HCMV感染的免疫学检测HC

13、MV抗原血症pp65、IE、p150.Ekaterina Maidji J Virol. 2007. .CMV的埋伏感染与再次激活宿主情况(安康或正常) 病毒埋伏(无临床病症)- 平衡形状 (突破平衡) 生物的 物理的 | 化学的 | 等等 埋伏的病毒 -激活(复制) .A 64 year old woman had taken oral corticosteroids for 2 years, in treatment of polymyalgia rheumatica. She now presents with abdominal pain and rectal bleeding. En

14、doscopic examination of the colon showed cecal ulcerations, and a partial bowel resection was ultimately undertaken. .HSV-1型所致唇疱疹.水痘-带状疱疹病毒感染所致的带状疱疹.结核病的病原体-结核分枝杆菌.弓形体-虫卵囊.传播途径的表示图.疱疹病毒(herps virus) 疱疹病毒的电镜照片.风疹病毒感染.梅毒(syphilis)惨白密螺旋体镜下形状暗视野)一种性传播性疾病梅毒螺旋体梅毒亚种感染所致人是独一宿主梅毒分先天/获得性梅毒诊治的参考目的: 血清挑选实验 血清学确诊实验.胎盘粘住头部 内脏外翻畸形斜视、脑瘫.孕妇CMV 感染的诊断.免疫球蛋白抗体的种类.用ELISA法检测外周血特异性抗体 CMV-IgM、IgG，判别结果： I