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,螺旋体(spirochete),特点,细长、弯曲、螺旋状、运动活泼的,原核细胞型微生物,具有轴丝内鞭毛，运动器,有细胞壁，有DNA和RNA,二分裂方式繁殖,对抗生素敏感。,Morphological comparison of,Leptospira,Borrelia,and Spirillum.,endoflagella,致病性螺旋体包括,310个螺旋,疏螺旋体属,回归热螺旋体 伯氏疏螺旋体,814个螺旋,密螺旋体属,梅毒螺旋体,1218个螺旋,钩端螺旋体属,钩端螺旋体Leptospira,一、生物学特性,根本结构：外膜、内鞭毛、原生质体,暗视野：运动活泼,钩端螺旋体镀银染色,一端或两端弯曲成钩状,培养特性,用Korthof液体培养基,10%兔血清,蛋白胨营养、促进生长、解毒,长链脂肪酸,VitB1、B12、B6,生物素疫苗制备时代替兔血清用,2830 需氧,分类,钩端螺旋体属包括,问号钩端螺旋体,双曲钩端螺旋体,前者致病，后者无致病性,问号钩端螺旋体有25个血清群，273个血清型；,抵抗力,在中性水和湿土中可存活半年以上。,对热、酸、青霉素敏感.,二、致病性,1强大的侵袭力,钩体的螺旋状结构、轴丝,酶：脂酶、透明质酸酶、尿素酶,2内毒素样物质类似脂多糖,发热、炎症坏死,3.溶血素类似磷脂酶,不耐热、对氧稳定,4.细胞毒性因子CTF：致肌肉痉挛和呼吸困难,5.致细胞病变物质：引起细胞退行性改变,致病物质,一传染源：,带菌动物鼠类、猪,二传播途径：,接触疫水、胎盘垂直传播,所致疾病,钩端螺旋体病，是人畜共患病。鼠类和猪是主要储存宿主,“Mastomys natalensis,a rat that carries diseases including plague,leptospirosis and toxoplasmosis,Figure 1.,Typical views of the residential areas of Belen,Iquitos,Peru.A.Houses near the river edge are built on stilts.B.Conditions abound for the proliferation of peridomestic rats in the same places where people live and play.This view is adjacent to the major market area of Belen,where,Rattus,spp.are commonly observed,even during the day in the middle of commercial activities.,Rats swarm a garbage heap at Valiyathura in the city even as maladies like leptospirosis begin their seasonal rounds in the State.,流行特征,地区性：农村地区发病率高,季节性：多雨温暖的夏秋季节，有“打谷黄、,“稻瘟病之称,职业性:农民,矿工等,流行形式：稻田型、洪水型、散发型,病程,钩体皮肤、粘膜血液各种组织出血、变性、坏死,1感染毒血症期早期,发病13d内,畏寒、高热、全身酸痛、腓肠肌酸痛,2器官损伤期中期,发病414d,肝、肾、心、肺、脑,3恢复期后发症期,发病714d后,临床表现,1.发热,2出血,3黄疸,4后发症,1后发热,2眼后发症,葡萄膜炎、虹膜睫状体炎,3神经系统后发症,脑膜炎、脑脊髓炎、脑动脉炎,免疫性,病后对同型钩体获得牢固免疫力,体液免疫为主,三、微生物学检查,一病原学检查,二血清学诊断,标本：血液、尿液、CSF、,1直接镜检:暗视野活体观察,2别离培养：接种Korthof液体培养基,1显微镜凝集试验:用当地常见的群、型抗原,2间接凝集试验:将抗原吸附在乳胶或活性炭微粒上,四、防治方法,一防鼠、灭鼠,二家畜的管理,三保护水源,四注意劳动保护，防止接触疫水,五免疫接种,1多价全细胞菌苗,2外膜菌苗,六抗菌治疗,青霉素、四环素、庆大霉素、强力霉素,梅毒螺旋体TP(Treponema pallidum),一、生物学性状,致密规那么螺旋,两端尖直,Fontana镀银染色,暗视野检查,培养特性,尚未真正成功,在棉尾兔单层上皮细胞中可培养几代.,Nichols有毒株兔睾丸,在含多种氨基酸的兔睾丸组织碎片中厌氧培养那么转变为无毒的 Reiter株,抵抗力,极弱,对枯燥、温度、化学消毒剂、青霉素、四,环素、红霉素、或砷剂敏感,致病性,致病物质,荚膜样物质：粘多糖、唾液酸,阻止抗体接触和补体活化,主要外膜蛋白:粘附、激活微血管粘附分子,释放炎症因子,透明质酸酶,有利于扩散,晚期梅毒的破坏作用主要与超敏反响引起的免疫病理损伤有关,所致疾病,梅毒,传染源：,TP感染者,传播途径,性接触、胎盘,1一期梅毒：3w，硬下疳，传染性极强,2二期梅毒：梅毒疹，LN肿大，传染性强3三期梅毒：传染性小，破坏性大,动脉瘤,脊髓痨,树胶肿,临床表现,1获得性梅毒(后天性梅毒,2胎传梅毒先天性梅毒,梅 毒,树胶肿,动脉瘤,Infection immunity,传染免疫,或,有菌免疫,免疫性,传染性免疫感染免疫，有菌免疫,1体液免疫,1抗TP抗体,2反响素reagin抗心磷脂抗体,2细胞免疫的强弱与疾病的转归,至关重要,而且迟发性变态反响所致的免疫病理,损伤与晚期梅毒的破坏性有关。,四、微生物学检查,1检查梅毒螺旋体,硬下疳渗出液、梅毒疹渗出液、局部淋巴结抽出液,暗视野观察或镀银染色,2非螺旋体血清试验,1VDRL试验,2USR试验,3RPR试验,3螺旋体血清试验,1荧光螺旋体抗体吸收FTA-ABS,2梅毒螺旋体血凝试验TPHA,Laboratory diagnosis,2.Serological tests,Infection with T.pallidum results in the rapid production of two types of antibody:,Specific antibodies directed primarily at polypeptide antigens of Treponema pallidum.,Non-specific antibodies(reagin反响素 antibodies)that react with a non-treponemal antigen called cardiolipin.,reagin反响素is a antibody elicited by self-antigen(phospholipids),Non-specific serological tests for syphilis,Cardiolipin,is a phospholipid extracted from beef heart,and it is possible that a similar substance,present in the treponemal cell membrane or released from host cells damaged by Treponema pallidum.,Non-specific serological tests for syphilis,Rapid plasma reagin(RPR)test,which has now largely superseded the earlier,Venereal Disease Research Laboratory(VDRL)test.,Immunoglobulin(Ig)M or IgG antibody present in positive sera causes a suspension of this lipoidal antigen to flocculate,and the result can be read rapidly by eye.,Both of these assays may be used as screening tests.,The upper,left-hand well shows a negative test result,since the carbon particles have remained unclumped.The clumped appearance of the carbon particles in the right-hand well indicate a positive test result,illustrating the flocculation of the cardiolipin-based antigen caused by antibodies in the test serum.,五、防治,1加强监测和管理,4积极早期治疗梅毒病人,5大剂量青霉素治疗,6疗程充分,7定期追踪观察,伯氏螺旋体Borrelia burgdorferi,是莱姆病lyme disease)的病原体,Giemsa或Wright染色，效果较好，2-100根内鞭毛,莱姆病是,自然疫源性疾病。,主要的储存宿主是鼠和鹿，主要传播媒介是硬蜱,临床表现,叮咬部位出现一到数个慢性移行性红斑,晚期慢性关节炎、神经系统、皮肤和心脏损害,慢性游走性红斑,预防,野外活动，注意个人防护,接种灭活疫苗,