董海艷《醫(yī)學(xué)微生物學(xué)》第10章 分枝桿菌屬

1、醫(yī)學(xué)微生物與免疫學(xué)教研室醫(yī)學(xué)微生物與免疫學(xué)教研室 董海艷董海艷 1 1、形態(tài)染色、形態(tài)染色mycobacteria結(jié)核桿菌結(jié)核桿菌acid-fast stain莢膜莢膜與細胞表面受體結(jié)合（粘附與入侵細胞）與細胞表面受體結(jié)合（粘附與入侵細胞）含多種酶（分解利用營養(yǎng)物質(zhì)）含多種酶（分解利用營養(yǎng)物質(zhì)）保護（防止有害物質(zhì)的進入菌體）保護（防止有害物質(zhì)的進入菌體） 抑制吞噬體與溶酶體融合抑制吞噬體與溶酶體融合脂質(zhì)脂質(zhì)索狀因子索狀因子（破壞線粒體，抑制中性粒細胞破壞線粒體，抑制中性粒細胞,引起肉芽腫引起肉芽腫）蠟質(zhì)蠟質(zhì)D D（引起遲發(fā)性過敏反應(yīng)）（引起遲發(fā)性過敏反應(yīng)）硫酸腦苷脂硫酸腦苷脂（抑制吞噬體與溶酶

2、體結(jié)合）（抑制吞噬體與溶酶體結(jié)合）蛋白質(zhì)蛋白質(zhì)即結(jié)核菌素，引起遲發(fā)性過敏反應(yīng)即結(jié)核菌素，引起遲發(fā)性過敏反應(yīng)致病物質(zhì)致病物質(zhì)磷脂磷脂（刺激單核細胞增生，形成結(jié)核結(jié)節(jié)）（刺激單核細胞增生，形成結(jié)核結(jié)節(jié)）Chest X-ray of severe pulmonary tuberculosis patient 以前感染過或免疫豚鼠以前感染過或免疫豚鼠正常豚鼠正常豚鼠24-48小時小時10-14天天局部紅腫、淺潰瘍局部紅腫、淺潰瘍局部紅腫、潰瘍局部紅腫、潰瘍 不擴散，不擴散，脫落后自行愈合脫落后自行愈合壞死，經(jīng)久不愈壞死，經(jīng)久不愈有毒有毒TB菌菌全身擴散全身擴散皮下皮下郭霍現(xiàn)象郭霍現(xiàn)象A TB skin

3、 test is typically performed on the forearm. After sterilizing the skin, a measured amount of PPD is injected intracutaneously.Within 48 to 72 hours, a positive TB skin test is marked by an area of reddish induration greater than 10 mm. It is the induration (firm bump) that is gently palpated that determines the size, not the area of redness. This reaction is slightly larger than the average positive test 1