,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,课件,*,第28章 疱疹病毒,(,Human herpesvirus,HHV),是有包膜的DNA病毒,立体对称,HHV1 HSV1,HHV2 HSV2,HHV3 水痘-带状疱疹病毒,HHV4 EB病毒,HHV5 CMV,HHV6,HHV7,HHV8 Kaposis肉瘤相关病毒,Electron micrograph of the herpesviruses.(from Armstrong D,Cohen J:,Infectious diseases,St Louis,2019,Mosby.),11/15/2024,1,课件,第28章 疱疹病毒Electron micro,第一节,单纯疱疹病毒,（,Herpes simplex virus,HSV）,分两型:HSV-1，HSV-2,传染源：病人、携带者（病毒存在疱疹病灶及唾液中）,传播途径：直接接触、性接触、飞沫,原发感染：,HSV-1：齿龈口腔炎、唇疱疹、角结膜炎（6月-2岁）,HSV-2:外生殖器疱疹,(80%，由HSV-2引起，20%HSV-1),11/15/2024,2,课件,第一节单纯疱疹病毒（Herpes simplex viru,1,2,3,潜伏感染,HSV-1：三叉神经节,HSV-2：骶神经节,复发时引起所支配皮肤粘膜疱疹,11/15/2024,3,课件,123潜伏感染10/5/20233课件,齿龈口腔炎,Primary herpes gingivostomatitis,(from Hart CA,Broadhead RL:,A color atlas of pediatric infectious diseases,London,1992,Wolfe),Mucosal ulceration and gingivitis typical of primary HSV-1 stomatitis in a child.,may also occur on the hard palate(which helps differentiate HSV infection from herpangina caused by coxsackie virus),Dwyer,DE267,11/15/2024,4,课件,齿龈口腔炎Primary herpes gingivosto,唇疱疹,Cold sore of recurrent herpes labialis.,It is less severe than that of primary disease.(From Hart CA,Broadhead RL:,A color atlas of pediatric infectious diseases,London,1992,Wolfe.),11/15/2024,5,课件,唇疱疹Cold sore of recurrent herp,先天性感染及新生儿感染,垂直感染畸形、智力低下、流产等,新生儿疱疹（产道）头皮等处，并可累及内脏（肺、肝、脑）死亡50%,HSV-2与宫颈癌（相关）,11/15/2024,6,课件,先天性感染及新生儿感染10/5/20236课件,微生物学检查,检查,病毒分离（水泡液，角膜拭子，阴道拭子进性细胞培养CPE）,快速诊断（电镜、免疫荧光、核酸测定）,血清学诊断：测抗体,防治,细胞免疫为主,无环鸟苷（ACV）治疗有效，,不能防止复发。,孕妇有HSV感染应剖腹产,11/15/2024,7,课件,微生物学检查10/5/20237课件,Virus can be obtained from vesicles but not crusted lesions.And produce CPE within-3 days in HeLa cells，Vero Cells,（kidney epithelial cells extracted from African green monkey）,et.Al.,11/15/2024,8,课件,Virus can be obtained from ves,第二节 水痘带状疱疹病毒,原发感染：,水痘,（儿童好发）,传染源：水痘患者（上呼吸道分泌物、水疱液）,带状疱疹患者（水疱液）,传播途径：飞沫、接触,致病机制：病毒在局部淋巴组织增殖病毒血症全身,11/15/2024,9,课件,第二节 水痘带状疱疹病毒10/5/20239课件,临床表现：,发热、全身皮肤丘疹、水疱（脓疱疹）,重症：免疫缺陷，成人，孕妇.,11/15/2024,10,课件,临床表现：10/5/202310课件,Characteristic rash of varicella in all stages of its evolution.(From Hart CA,Broadhead RL:,A color atlas of pediatric infectious diseases,London,1992,Wolfe.),1papule,2,3vesicle,4pus,5crust,11/15/2024,11,课件,Characteristic rash of varicel,11/15/2024,12,课件,10/5/202312课件,带状疱疹,儿时曾患水痘,潜伏感染,病毒,潜伏,脊髓后根神经节,脑神经感觉神经节,激活,N所支配皮肤发生疱疹,(群集性水疱），,呈带状，身体一侧，多在胸、腹、臀、面部。疼痛,侵犯坐骨N,11/15/2024,13,课件,带状疱疹病毒潜伏脊髓后根神经节激活N所支配皮肤发生疱疹(群集,Herpes zoster(shingles)in a thoracic dermatome,(n.intercostales5-6),11/15/2024,14,课件,Herpes zoster(shingles)in a,Herpes zoster affecting the third division of fifth cranial(trigeminal)nerve，including the lingual nerve，in a old patient，showing necrotic tissue,（疱壁、坏死、痂皮、潮湿）,.,Dwyer,DE267,11/15/2024,15,课件,Herpes zoster affecting the th,第三节 EB病毒（EBV）,1964年 ，由 Epstein和Barr研究非洲儿童淋巴瘤病发现该病毒，故用两人名字字头命名。,为一种嗜B淋巴细胞的疱疹病毒，结构与其它疱疹病毒相似,Electron of the EB virus.X100,000,George Musil/Visuals Unlimited,11/15/2024,16,课件,第三节 EB病毒（EBV）196,传染源：病人、隐性感染者、抗体（+）排毒者,传播途径：唾液感染（接吻、呼吸道）,相关疾病传染性单核细胞增多症,非洲儿童恶性淋巴瘤,鼻咽癌,A child with Burkitts lymphoma,Custom Medical Stock Photo,Inc,11/15/2024,17,课件,传染源：病人、隐性感染者、抗体（+）排毒者A child w,EBV引起鼻咽癌的依据：,鼻咽癌活检组织中找到EBV 核酸和抗原。,鼻咽癌患者血中EBV相关抗原的抗体效价高于正常人。,鼻咽癌经治疗后，抗体效价下降。,但除EBV外，还应有其他因素起作用。,我国广东、广西、福建等地高发。,11/15/2024,18,课件,EBV引起鼻咽癌的依据：10/5/202,微生物学检查,分离培养困难,EBV DNA,EBV特异性抗体,异嗜性抗体：能使绵羊红细胞凝集,防治:,疫苗,11/15/2024,19,课件,微生物学检查10/5/202319课件,第四节 人巨细胞病毒,（Cytomegalovirus，CMV）,原发感染：2岁以下常隐性感染（成人60-90%有抗体）,潜伏感染：在唾液腺、乳腺、肾脏、宫颈、阴道、白细胞及其它腺体中，与其它疱疹病毒不同之处从以上腺体中间歇性排毒（分泌物中）,传染途径：接触、性接触、输血、器官转移等,11/15/2024,20,课件,第四节 人巨细胞病毒（Cytomegalovirus，C,感染类型,先天性（宫内）感染：0.5-2.5%，可引起畸形、流产。,围生期感染：产道、乳汁、医护人员。,免疫功能低下者感染：器官转移,输血感染,性接触感染,与肿瘤关系（宫颈癌、前列腺癌、结肠癌、Kaposi肉瘤）,11/15/2024,21,课件,感染类型10/5/202321课件,H&E stain of lung section showing nuclear inclusions with the appearance of an owls eye.The inclusion is surrounded by a clear halo that extends to the nuclear membrane.CMV infection can occur without the typical cytomegalic cells.,细胞学检查,细胞肿大，核变大，形成巨大细胞,核内大型嗜碱性包涵体，外周有“晕”如“猫头鹰眼”,11/15/2024,22,课件,H&E stain of lung section show,第五节 其它,HHV-6：幼儿急疹（6月2岁，热退疹出）,HHV-7：幼儿急疹（发病年龄略晚）,HHV-8：与Kaposi肉瘤（KS）有关，主要见于AIDS患者,Cutaneous Kaposis Sarcoma,Multiple oval,dark red,purple plaques present on chest and arms.,From:depts.washington.edu,11/15/2024,23,课件,第五节 其它HHV-6：幼儿急疹（6月2岁，热退疹,