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第三篇医学相关病毒肠道病毒Gastrointestine-InfectedViruses教学大纲掌握内容肠道病毒种类及共同特性脊髓灰质炎病毒主要生物学性状、致病性、微生物学检查法及防治原则柯萨奇病毒分组、分型及致病性熟悉内容埃可病毒、肠道病毒70型、肠道病毒71型的致病性问题肠道病毒有哪些？是不是肠道感染的所有病毒都称为肠道病毒？简要说明肠道病毒的特性脊髓灰质炎病毒的传播途径、致病机制是什么？如何预防脊灰？B组柯萨奇病毒的致病有何特点？ECHO病毒、轮状病毒、杯状病毒、小圆结构病毒分别与哪些疾病有关？GroupsandSerotypesPicornaviridae（小RNA病毒科）Atleast71serotypes,dividedinto4subgroupsPolioviruses（脊髓灰质炎病毒）Coxsackieviruses（柯萨奇病毒）Echoviruses（埃可病毒）Newenteroviruses（新肠道病毒）morerecently,newenterovirusessubtypehavebeenallocatedsequentialnumbers(68-71))EnterovirusesSerotypesMorphology27nm,icosahedralsymmetry,noenvelopeEnterovirusstructureSurfacecleft–attachmenttocellularreceptors:Immunoglobulinsuperfamily,integrins,ICAM-1肠道病毒特点生物学性状小球形病毒（~30nm），无包膜核酸为+ssRNA，有感染性衣壳蛋白VP1-VP3分布在表面，VP4与RNA结合在胞浆增殖，有明显CPE，破胞释放耐酸耐乙醚，但鼻病毒除外引起多种疾病麻痹、无菌性脑膜炎、心肌损伤、腹泻、皮疹脊髓灰质炎病毒（Poliovirus）Firstidentifiedin1909byinoculationofspecimensintomonkeysFirstgrownincellculturein1949whichbecamethebasisforvaccinesTransmissionFecal–oralroute(粪－口途径)viahandsandobjects viafoodandwaterThefirstwrittenrecordofvirusinfectionAheiroglyphfromMemphis,drawninapproximately1400BC,whichdepictsatemplepriestcalledSiptahshowingtypicalclinicalsignsofparalyticpoliomyelitisFranklinD.RooseveltInthesummerof1921,whenhewas39,disasterhit-hewasstrickenwithpoliomyelitis.Demonstratingindomitablecourage,hefoughttoregaintheuseofhislegs,particularlythroughswimming.ManifestationsMostinfectionsasymptomatic,95%Abortivepolio(minorillness),5%fever,malaise,sorethroat,myalgia,headacheAsepticmeningitis(nonparalyticpolio),1%Paralyticpolio(majorillness),0.1%asymetricflaccidparalysis/paresis.Lower,orupperextremitiesPost-poliosyndromeprogressiveatrophyyearslater免疫性牢固特异免疫，体液免疫为主肠道局部sIgA血液中和性IgG、IgM抗体中和抗体可长时间维持（终生）3型间交叉保护极弱LaboratoryDiagnosisVirusIsolationSerology预防原则流行期不宜做小儿扁挑体摘除术和其他疫苗接种疫苗接种：最好的手段被动免疫：易感者用丙种球蛋白CurrentStatusofWildPoliovirusTransmission我国政府规定每年12月5日和1月5日为脊灰疫苗日。柯萨奇病毒（Coxsackievirus）1948年美国纽约州Coxsackie镇一名疑似脊髓灰质炎的患儿粪便中用乳鼠接种的方法分离发现GroupsGroupAviruses(23types)GroupBviruses(6types)DistinguishedfromotherenterovirusesbytheirpathogenicityforsucklingmiceGroupbasedonthelesionsinsucklingmice.PathogenesisFecal-OralroutetrasmissionSpreadinthebodylikepoliovirusesDiseaseAssociationsParalyticDiseaseMeningitisEncephalitisUndifferentiatedfebrileillnessHandfootmouthdiseaseHerpanginaEpidemicPleurodynia(Bornholmdisease)Myocarditis

RespiratoryInfectionsRubelliformrashesNeonatalInfectionConjunctivitisPancreatitis/DiabetesExanthems-RubelliformrashesEVleadingcauseinsummer&fall.AlltypesofrashHand-foot-and-mouthdiseaseHand-foot-and-mouthdisease:mostlycoxackieAfever,malaise,sorethroat,vesiclesonbucalmucosa,tongue,hands,feet,buttockshighlyinfectiousresolution–1wHerpanginaHerpangina–usuallycoxackieAacuteonset,fever,sorethroat,dysphagia

lesions–posteriorpharynxcanpersistw’snogingivitisLaboratoryDiagnosisVirusIsolationSerologyManagementandPreventionThereisnospecificantiviraltherapyavailableagainstenterovirusesotherthanpolio.IVIGHNIGThereisnovaccineEchovirusesThefirstechoviruseswereaccidentallydiscoveredin1951duringepidemiologicalstudiesofpolioviruses.CPEincellculturesTypesThereare32echoviruses

NogroupAgPathogenesis主要导致无菌性脑炎、类脊髓灰质炎等感染后对同型病毒可产生持久免疫诊断困难尚无疫苗预防以隔离为主DiseasesassociatedwithEnterovirusesNewEnteroviruses4newenteroviruses(68-72)Enterovirus71appearstobehighlypathogenicandhasbeenassociatedwithepidemicsofavarietyofacutediseasesEnterovirus72wasassignedtoanewfamilycalledheptoviruses肠道病毒70型

病毒存在于眼结膜接触传播引起急性出血性结膜炎（俗称“红眼病”）。本病起病急，潜伏其为1d,病程8~10d，主要侵犯眼结膜，引起结膜下出血，愈后良好。该病毒还具有一定的嗜神经性，侵犯中枢神经系统，出现腰骶脊神经根炎，引起下肢麻痹。

肠道病毒71型小RNA病毒可在原代细胞中增殖，但敏感性差，能引起乳鼠病变。耐热、耐酸，可抵抗70%的乙醇，高温和紫外线照射很快可将其灭活。

感染多发于夏、秋，10岁以下儿童多见。主要通过粪—口途径或密切接触传播，潜伏期一般3～5d，人是其目前已知的惟一宿主。感染后多数情况下不引起明显的临床症状，但有时也可导致被感染者出现比较严重的疾。饕ㄊ肿憧诓、无菌性脑膜炎和脑炎、疱疹性咽峡炎以及类脊髓灰质炎等疾病。小结肠道病毒种类及共同特性脊髓灰质炎病毒主要生物学性状、致病性、微生物学检查法及防治原则柯萨奇病毒分组、分型及致病性埃可病毒、肠道病毒70型、肠道病毒71型的致病性