章、细菌感染检查与防治

Chapter5BacterialinfectiousdiagnosisandpreventionDiagnosisforPathogenicBacteriumSignsandsymptomsvaryaccordingtothesiteandseverityofinfection.Diagnosisrequiresacompositeofinformation,includinghistory,physicalexamination,radiographicfindings,andlaboratorydata.

laboratoryAssaysMorphologicalassaysLightorelectronmicroscopyIsolationanddifferentiationSerologicalassaysAntigen-antibodyassaysMolecularassaysMicroorganism’sgene(DNA&RNA)DiagnosisofEtiology:

Goldenstandardistodetectthepathogenicbacterium

SpecimenCollectionandProcessingObtainspecimensfromtheinfectedsiteAvoidcontaminationfromthenormalfloraTransportingandstoringcorrectlyBeforeantimicrobialdrugsareadministered.

ProvidingessentialinformationGeneralprocedureforcollectingandprocessingspecimensforaerobicand/oranaerobicbacterialculture

Directassay

MorphologicalAssayElementAssayToxinAssay

MorphologicalAssayNon-stainedmicroscopicobservationDark-fieldmicroscopyObservingthemovementoflivebacteriaStainedmicroscopicobservationsGramstainAcid-faststainFluorescencestain

ElementAssayAntigendetectionNucleicaciddetectionToxindetectionAntigendetectionCoagglutinationtestPrecipitationtestELISAFluoroimmunoassay,FIARadioimmunoassay,RIACoagglutinationtestFluoroimmunoassay,FIANucleicaciddetectionNucleotidehybridizationPCRGenechipPCRGeneChip/microarrayToxindetectionEndotoxindetection--LimulustestExotoxindetection--ElekplatetestAnimaltest--LD50,ID50LimulustestElekplatetest

Culture&Identify

Isolation&CultureIdentifyMorphologicalidentifyBiochemicalreactionSerologicalassaysAntibioticssusceptibilitytestOthersIsolation&Culture:ColonySizeShapeColorSurfacefeaturesSmooth-RoughTransparencyHemolysis

BiochemicalReactions

SugarFermentationH2STestCitrateutilization

DiffusionMethodMIC&MBCMinimumInhibitoryConcentration，MICMinimumBactericidalConcentration，MBCBactericidaldrugsusuallyhaveanMBCequalorverysimilartotheMICBacteriostaticdrugsusuallyhaveanMBCsignificantlyhigherthantheMICEtestDiffusionmethod

+Dilutionmethod

SerologicalDiagnosis

Detectionantibodiesinthepatient’sserum

Acurrentinfectionshouldbe

IgMpositiveA4-foldorgreaterriseonantibodytiterbetweentheacuteserumsampleandtheconvalescentserumsample

AgglutinationtestComplementfixationtestNeutralizationtestELISAWesternblotanalysisSpeciesAsingleIgGantibodytiterisdifficulttointerpretbecauseitisunclearwhetheritrepresentsacurrentorapreviousinfectiontheconvalescentsampleisusuallytaken10-14daysaftertheacutesample.Bythistime,thepatienthasoftenrecoveredandthediagnosisesaretrospectiveoneMajordisadvantagePreventionandTreatmentofbacterialinfectionPreventionArtificialimmunityInnateimmunityActiveimmunityPassiveimmunity

Specific

PreventionActiveimmunityPassiveimmunityPreventionPassiveimmunityActiveimmunityVaccinesAdjuvantsCytokine,LAKcellAntiserum,AntitoxinsToxoidsImmunoglobulin

Vaccinesareantigenspreparedfrompathogensthatcanraiseaprotectiveimmuneresponse,yetdonotcauseillness.

ArtificialactiveimmunityVaccinesInactivatedvaccinesLive(attenuated)vaccinesSubunitvaccinesGeneengineeredvaccineDNAvaccinesToxoidInactivatedvaccine&Attenuatedvaccine较高，维持3~5年甚至更长较低，维持数月~2年免疫效果不易保存，4℃数周易保存，约1年保存及有效期量较小，1次量较大，2~3次接种剂量与特点活减毒株死，强毒株制剂特点活疫苗死疫苗区别点Antitoxin:

e.g.Tetanusantitoxinanddiphtheriaantitoxin

AntiserumImmunoglobulinCytokine

Artificialpassiveimmunityinvolvesgivingbothavaccinetoprovidelong-termprotection(preventiveinfection)andimmuneglobulintoprovideimmediateprotection(therapeuticandpreventiveinfectiousdisease).Active-passiveimmunityArtificialactiveandpassiveimmunityTreatoremergencyprevebtionPreventionMainusageshort，2~3WLong,severalyears~severalmonthsDurationFastslow，2~4WTimeofresponseAntibody,cytokineAntigensubstancePassiveimmunityAvtiveimmunityitms国家免疫规划疫苗:2008年2月

以前:乙肝疫苗、卡介苗、脊灰疫苗、百白破疫苗、麻疹疫苗08:甲肝疫苗、流脑疫苗、乙脑疫苗、麻风腮疫苗重点人群和地区：出血热疫苗、炭疽疫苗、钩体疫苗预防的传染病15种: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、炭疽、钩体

AntimicrobialchemotherapyChemotherapyasasciencebeganwithPaulEhrlichinthefirstdecadeofthe20thcentury.Ehrlich’sexperimentsledtothearsphenamines(胂凡纳明)forsyphilis,thefirstplannedchemotherapy.金葡菌菌血症的死亡率

RubinRJetal.EmergingInfectDis1999;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8%，世界抗感染药物市场销售额为400亿美元，约占全球治疗性药物市场的10%。各类抗感染药具体销售情况是：抗生素占最大份额(约250亿～260亿美元)；抗病毒药居第二位(约55亿～56亿美元)；第三位为抗真菌药(40亿～42亿美元)；其余则为疫苗和抗原生动物药等抗感染药小品种。