出血热病毒-医学微生物学课件

DepartmentofMicrobiology,HarbinMedicalUniversityDepartmentofMicrobiology,HarbinMedicalUniversityMedicalMicrobiology医学微生物学DepartmentofMicrobiology,HMU哈尔滨医科大学微生物学教研室DepartmentofMicrobiology,HarbinMedicalUniversity第三篇医学相关病毒第34章出血热病毒HaemorrhagicFevervirus微生物学教研室宋武琦DepartmentofMicrobiology,HarbinMedicalUniversity教学大纲掌握内容汉坦病毒主要生物学性状，包括形态结构、培养特性、抗原分型及抵抗力；流行环节及致病性;微生物学检查法。新疆出血热病毒致病性及传播媒介了解内容肾综合征出血热病毒及新疆出血热病毒防治原则；非洲出血热病毒（埃博拉病毒和马堡热病毒）的传播方式及引起疾病DepartmentofMicrobiology,HarbinMedicalUniversityHistoryHaemorrhagicFeverwithRenalSyndrome(HFRS:laterrenamedhantavirusdisease,HVD)firstrecognizedinHeilongjiang,Chinainthe1930s,andcametotheattentionoftheWestduringtheKoreanwarwhenover3000UNtroopswereafflictedIttranspiredthatthediseasewasnotnewandhadbeendescribedbytheChinese1000yearsearlierIn1974,thecausativewasisolatedfromtheKoreanStrippedfieldmiceandwascalledHantaanvirusIn1995,anewdiseaseentitycalledhantaviruspulmonarysyndromewasdescribedinthe“fourcorners”regionoftheU.S.DepartmentofMicrobiology,HarbinMedicalUniversity病毒体VirionFormsaseparategenusintheBunyavirusfamily布尼雅病毒科Unlikeotherbunyaviridae,itstransmissiondoesnotinvolveanarthropodvectorEnveloped-ssRNAvirusVirions98nmindiameterwithacharacteristicsquaregrid-likestructure.GenomeconsistsofthreeRNAsegments:L,M,andS.DepartmentofMicrobiology,HarbinMedicalUniversity基于中和试验的血清型SubtypesofHantavirusesBasedNT黑线姬鼠型褐家鼠型欧洲棕背鼠型草原田鼠型巴尔干姬鼠型小家鼠型黑线姬田鼠小家鼠DepartmentofMicrobiology,HarbinMedicalUniversity根据抗原和基因结构分型（10型）Hantaan（汉滩型）Seoultype（汉城型）PuumalatypeSinNombre（辛诺柏型）DepartmentofMicrobiology,HarbinMedicalUniversity流行病毒学EpidemiologyNaturalhost:RodentApodemusagrarius(Strippedfieldmice,黑线姬鼠)传染源：黑线姬鼠、褐家鼠、大林姬鼠Viralcontaminationcomesfromrodenturine,stool,salivarysecretionSeasonalandregionaldistribution(autumnandwinter,Oct.-Jan.)Theinfectionrouteisstilluncertain.Thepossibleentriesarerespiratorytract,mouth,anddirectcontactRodentCarriersofHantavirusesStrippedfieldmouse(Apodemusagrarius)Bankvole(Clethrionomysglareolus)DeerMouse(Peromyscusmaniculatus)Rat(Rattus)DepartmentofMicrobiology,HarbinMedicalUniversity临床特点ClinicalFeaturesIncubation:2weeks,HFRSPathogenesismechanismisunknown.Immunologicalreactionmayplayrole极低的隐性感染率Verylowsubclinicalinfectionrate(1-4%)病后稳定的免疫力，一般不再发病Stablehumoralimmunity.norepeatinfectionDepartmentofMicrobiology,HarbinMedicalUniversity致病性PathogenesisThemultisystempathologyofHVDischaracterizedbydamagetocapillariesandsmallvesselwalls,resultinginvasodilationandcongestionwithhemorrhagesClassically,hantavirusdiseaseconsistsof5distinctphases.ThesephasesmaybeblurredinmoderateormildcasesDepartmentofMicrobiology,HarbinMedicalUniversityFebrilephase发热期Hypotensivephase低血压期Oliguricphase少尿期Diureticphase多尿期Convalescentphase恢复期DepartmentofMicrobiology,HarbinMedicalUniversityNephropathiaFarEasternRat-bourneBalkanEpidermicaHVDHVDHVDVirustypePuumalaHantaanSeoulPorogiaOverallSeverity1-22-41-32-4MultiphasicDiseaseoccasionallyYesBlurredYesRenalAbnormalities1-241-24Hepaticabnormalities00-11-30-1Haemorrhagicphenomenon0-11-41-21-4Mortality1%5-10%1%5-35%Score=0to4ComparativeClinicalFeaturesofRecognizedHantavirusDisease(HVD)DepartmentofMicrobiology,HarbinMedicalUniversity汉坦病毒肺综合征HantavirusPulmonarySyndromeThemajorityofcasesarecausedbytheSinNombrevirus（汉坦病毒属辛诺柏病毒）Morethan250casesofHPShavebeenreportedthroughoutNorthandSouthAmericawithamortalityrateof50%DepartmentofMicrobiology,HarbinMedicalUniversity诊断Diagnosis血清学诊断直接检测病毒抗原RT-PCR病毒分离Virusisolation免疫组化DepartmentofMicrobiology,HarbinMedicalUniversity治疗和预防TreatmentofHVDandHPSdependsmainlyonsupportivemeasures支持疗法Ribavirin利巴韦林VaccinationRodentControlDepartmentofMicrobiology,HarbinMedicalUniversity新疆出血热病毒XinjiangHemorrhagicFeverVirus1966年首次从新疆塔里木盆地出血热病人血液、尸体脏器及硬蜱中分离流行病学及病毒抗原性与克里米亚-刚果出血热病毒（Crimean-Congohemorrhagichevervirus，CCHFV）相似XHFV与CCHFV同种，属布尼雅病毒科（Bunyaviridae）内罗病毒属（nairovirus）DepartmentofMicrobiology,HarbinMedicalUniversity生物学性状球形或椭圆形，直径为90nm～120nm，外有包膜，表面有空管样突起病毒基因组为分节段的-ssRNA出生后l～4天的乳鼠对XHFV最为敏感，常用于病毒分离及传代。用VeroE6等细胞培养病毒不产生CPE，可用免疫荧光法通过检测感染细胞的胞浆内可形成嗜碱性包涵体DepartmentofMicrobiology,HarbinMedicalUniversity致病性与免疫性野生动物（啮齿类动物）和家畜（羊、牛、马、骆驼、狐狸和兔）是自然宿主和传染源。羊在维持XHF疫原上起重要作用硬蜱特别是亚洲璃眼蜱（hyalommaasiaticum）是传播媒介。病毒在蜱体内增殖并经卵传给子代，蜱也是病毒的长期储存宿主DepartmentofMicrobiology,HarbinMedicalUniversity蜱在每年的4月～6月大量增殖人群发病的高峰蜱叮咬或与病畜直接接触（破损皮肤）感染5～7天潜伏期发病，以发热和出血为特征产生中和（NT）抗体、血凝抑制抗体NT抗体出现较早，维持较久病后可获得持久免疫力DepartmentofMicrobiology,HarbinMedicalUniversity微生物学检查法确诊主要依赖于病毒的分离鉴定患者双份血清中特异性抗体的检查DepartmentofMicrobiology,HarbinMedicalUniversity防治原则防蜱咬和灭蜱严格隔离病人加强医务人员的防护灭活疫苗DepartmentofMicrobiology,HarbinMedicalUniversity埃博拉病毒非洲出血热（Africahemorrhagicfever）主要包括埃博拉热（Ebolafever）和马堡热（Marburgfever），分别由埃博拉病毒（Ebolavirus）和马堡病毒（Marburgvirus）感染所致两种病毒均为RNA病毒，同属于丝状病毒科（Filoviridae）的丝状病毒属（filovirus），形态结构酷似，但抗原性明显不同DepartmentofMicrobiology,HarbinMedicalUniversity致病性非洲出血热的主要临床特点储存宿主是啮齿类动物人与人主要通过密切接触及体液（尿或粪便）等的污染而传播目前尚无特异性防治措DepartmentofMicrobiology,HarbinMedicalUniversity小结病毒科病毒疾病传播媒介储存宿主黄病毒科乙脑病毒登革病毒森林脑炎病毒乙脑登革热森林脑炎库蚊伊蚊蜱库蚊伊蚊蜱布尼亚病毒科汉坦病毒流行性出血热鼠Departmentof