感染性疾病實(shí)驗(yàn)診斷

1、關(guān)于感染性疾病的實(shí)驗(yàn)診斷第一張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月前 言實(shí)驗(yàn)診斷學(xué)(laboratory diagnosis) 是診斷學(xué)的一部分,它是基礎(chǔ)醫(yī)學(xué)向臨床醫(yī)學(xué)過渡的橋梁課程之一。實(shí)驗(yàn)診斷學(xué)的任務(wù)是將臨床檢驗(yàn)所提供的檢驗(yàn)信息，通過醫(yī)師的分析和思維，科學(xué)地應(yīng)用于臨床診斷、鑒別診斷、觀察病情、判斷預(yù)后、預(yù)防疾病的一門學(xué)科，特別強(qiáng)調(diào)在循證實(shí)驗(yàn)醫(yī)學(xué)的原則下推行“實(shí)驗(yàn)的優(yōu)化組合應(yīng)用”和“在實(shí)驗(yàn)監(jiān)測(cè)下作個(gè)體化治療的應(yīng)用”，實(shí)驗(yàn)診斷學(xué)也可稱為臨床檢驗(yàn)診斷學(xué)。因此，它是醫(yī)學(xué)生的必修課，必須加以重視。第二張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月 感染性疾病的實(shí)驗(yàn)診斷第三張，PPT共一百三十

2、二頁(yè)，創(chuàng)作于2022年6月主要學(xué)習(xí)內(nèi)容及要求掌握感染性疾病的常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目及其臨床意義和評(píng)價(jià)不同病原體感染性疾病實(shí)驗(yàn)室檢測(cè)與不同系統(tǒng)病原體感染性疾病實(shí)驗(yàn)室檢測(cè)特點(diǎn)熟悉引起血流感染、中樞神經(jīng)系統(tǒng)感染、呼吸系統(tǒng)感染、 消化系統(tǒng)感染、 泌尿系統(tǒng)感染、皮膚及軟組織感染和先天及新生兒感染常見病原體與常見疾病及病原學(xué)檢查、常見醫(yī)院感染病原體及特點(diǎn)、醫(yī)院感染的微生物學(xué)檢測(cè)及醫(yī)院感染暴發(fā)流行的識(shí)別和處理了解當(dāng)今感染病特點(diǎn)、感染類型第四張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Specimen Collection Successful laboratory diagnosis of a microbi

3、al infection depends on many factors beginning with a well-collected sample. Proper specimen selection, collection, and transport are all essential to ensure that a specimen is representative of the disease process and minimally contaminated with microorganisms present in adjacent tissues. 第五張，PPT共一

4、百三十二頁(yè)，創(chuàng)作于2022年6月Site and TimingCollect the sample from the correct anatomic site . eg. a superficial sample of a lesion is not useful in identifying the cause of a deep wound infection. The timing of sample collection is also important. eg, when submitting a specimen for bacterial culture, samples s

5、hould be collected before the administration of antibiotics 第六張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Collection TechniquesSufficient volume Sterile technique and equipment. After collection, the specimen must be placed in an appropriately labeled leak-proof container. 第七張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Transport of Specimens

6、Rapid, optimally in less than 2 hours. For delays in transport, most specimens should be refrigerated.Exceptions: blood, cerebrospinal fluid (CSF), and specimens to be examined for anaerobes, fastidious organisms such as Neisseria gonorrboeae and Bordetella pertussis, and Trichomonas vaginalis, all

7、of which should be maintained at room temperature. 第八張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月難點(diǎn)/重點(diǎn)解讀（一）細(xì)菌感染性疾病常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合（二）病毒感染性疾病常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合（三）真菌感染性疾病常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合（四）寄生蟲感染性疾病常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合第九張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月細(xì)菌感染性疾病 常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合 1. 感染病的實(shí)驗(yàn)診斷方法雖按基本原則進(jìn)行，但細(xì)感染性疾病具下述特點(diǎn)： 在檢查項(xiàng)目中，尤其以細(xì)菌分離培養(yǎng)鑒定為主。在無菌標(biāo)本中檢查到細(xì)菌，則此細(xì)菌為感染的病原；存在

8、正常菌群的標(biāo)本中檢查到細(xì)菌，應(yīng)區(qū)分是正常寄居的菌群或是致病的細(xì)菌，常需要作細(xì)菌定量計(jì)數(shù)，根據(jù)細(xì)菌數(shù)判斷是否為感染的病原菌。 第十張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月細(xì)菌感染性疾病 常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合2. 根據(jù)目的不同，檢測(cè)項(xiàng)目的選擇是： （1）診斷疾病的病原學(xué)，一般情況下只需鑒定到細(xì)菌的 種，必要時(shí)再進(jìn)一步鑒定； （2）提供治療方案，可以進(jìn)行臨床標(biāo)本的直接藥物敏感 試驗(yàn)，還可根據(jù)分離出病原菌的種類直接提供選擇 抗生素的范圍和種類； （3) 研究流行病學(xué)，必須對(duì)病原菌做進(jìn)一步鑒定，往往 鑒定到型（血清型或基因型）的水平； (4) 要了解這類細(xì)菌的致病性，必須進(jìn)行細(xì)致鑒定，包 括毒

9、素、侵襲性酶類的檢測(cè)。 第十一張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月（一）細(xì)菌感染性疾病常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合 3.根據(jù)標(biāo)本來源，通常構(gòu)成不同組合的檢驗(yàn)方法： （1）無菌性標(biāo)本（血液、腦脊液、體腔滲出液），采用顯微鏡檢查和直接藥敏試驗(yàn)可作為病原學(xué)診斷和提供臨床治療用藥指導(dǎo)； （2）膿血便，采用革蘭染色無診斷意義，需用標(biāo)記抗體染色鏡檢獲初步報(bào)告，再需經(jīng)選擇培養(yǎng)基分離培養(yǎng)，挑取可疑菌落作玻片血清凝集，陽(yáng)性者可初步鑒定，再用配套生化反應(yīng)可作出最后報(bào)告； （3）尿液標(biāo)本，顯微鏡檢查可初步估計(jì)細(xì)菌菌量，作出初步診斷，再經(jīng)分離培養(yǎng)鑒定后和菌落定量計(jì)數(shù)可作出病原學(xué)診斷；痰標(biāo)本，采用顯微鏡檢查，判定

10、是否為合格標(biāo)本，若為合格標(biāo)本作分區(qū)劃線接種，檢出致病性菌落，再進(jìn)行鑒定和藥敏。 第十二張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月細(xì)菌感染性疾病常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合4.結(jié)果報(bào)告可由實(shí)驗(yàn)室人員可分別出具： 先后和程度不同報(bào)告各檢測(cè)項(xiàng)目（顯微鏡檢查、 分離培養(yǎng)、血清學(xué)試驗(yàn)、生化鑒定和PCR等核酸 檢測(cè)）結(jié)果，為臨床提供信息。5.為保證細(xì)菌感染正確診斷，必須遵循下述細(xì)菌感染診斷原則：要求醫(yī)師和檢驗(yàn)師的密切配合，不應(yīng)停留在化驗(yàn)單往來；重視檢驗(yàn)標(biāo)本的采集和送檢；重視檢驗(yàn)過程的階段性和連續(xù)性；檢驗(yàn)程序需有針對(duì)性和綜合性。第十三張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Ba

11、cteria that Cause DiseasePrinciples of Diagnostic Medical MicrobiologyIntroductionDiagnostic medical microbiology is concerned with the etiologic diagnosis of infection. Laboratory procedures used in the diagnosis of infectious disease in humans include the following:第十四張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identi

12、fying Bacteria that Cause DiseasePrinciples of Diagnostic Medical Microbiology(1) Morphologic identification of the agent in stains of specimens or sections of tissues (light and electron microscopy).(2) Culture isolation and identification of the agent.(3) Detection of antigen from the agent by imm

13、unologic assay (latex agglutination, EIA, etc) or by fluorescein-labeled (or peroxidase-labeled) antibody stains.第十五張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseasePrinciples of Diagnostic Medical Microbiology(4) DNA-DNA or DNA-RNA hybridization to detect pathogen-specific genes in pat

14、ients specimens.(5) Detection and amplification of organism nucleic acid in patients specimens.(6) Demonstration of meaningful antibody or cell-mediated immune responses to an infectious agent.第十六張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseasePrinciples of Diagnostic Medical Microbiol

15、ogyPhysicians who deal with infectious processes must know when and how to take specimens, what laboratory examinations to request, and how to interpret the results. Clinical information is much more important for diagnostic microbiology than it is for clinical chemistry or hematology. The clinician

16、 must make a tentative diagnosis rather than wait until laboratory results are available. 第十七張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseasePrinciples of Diagnostic Medical MicrobiologyCommunication between Physician & Laboratory As the laboratory staff begins to obtain results, they

17、inform the physician, who can then reevaluate the diagnosis and clinical course of the patient and perhaps make changes in the therapeutic program. This feedback information from the laboratory consists of preliminary reports of the results of individual steps in the isolation and identification of

18、the causative agent.第十八張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause Disease Diagnosis of Bacterial InfectionsSpecimensLaboratory examination usually includes microscopic study of fresh unstained and stained materials and preparation of cultures with conditions suitable for growth of a wide

19、 variety of microorganisms, including the type of organism most likely to be causative based on clinical evidence. 第十九張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseDiagnosis of Bacterial InfectionsSpecimensIf a microorganism is isolated, complete identification may then be pursued. I

20、solated microorganisms may be tested for susceptibility to antimicrobial drugs. When significant pathogens are isolated before treatment, follow-up laboratory examinations during and after treatment may be appropriate.第二十張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseDiagnosis of Bact

21、erial Infections SpecimensSpecimensA properly collected specimen is the single most important step in the diagnosis of an infection, because the results of diagnostic tests for infectious diseases depend upon the selection, timing, and method of collection of specimens. 第二十一張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Id

22、entifying Bacteria that Cause DiseaseDiagnosis of Bacterial Infections SpecimensSpecimensRecovery of bacteria is most significant if the agent is isolated from a site normally devoid of microorganisms (a normally sterile area). Any type of microorganism cultured from blood, cerebrospinal fluid, join

23、t fluid, or the pleural cavity is a significant diagnostic finding. Conversely, many parts of the body have a normal microbial flora( respiratory, gastrointestinal, or genitourinary tracts; from wounds; or from the skin) must be considered in the context of the normal flora of each particular site.

24、第二十二張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseDiagnosis of Bacterial Infections SpecimensSpecimensA few general rules apply to all specimens:(1) The quantity of material must be adequate.(2) The sample should be representative of the infectious process (eg, sputum, not saliva; pu

25、s from the underlying lesion, not from its sinus tract; a swab from the depth of the wound, not from its surface). (3) Contamination of the specimen must be avoided by using only sterile equipment and aseptic precautions.第二十三張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseDiagnosis of

26、Bacterial Infections Specimens(4) The specimen must be taken to the laboratory and examined promptly. Special transport media may be helpful.(5) Meaningful specimens to diagnose bacterial and fungal infections must be secured before antimicrobial drugs are administered. If antimicrobial drugs are gi

27、ven before specimens are taken for microbiologic study, drug therapy may have to be stopped and repeat specimens obtained several days later.第二十四張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseDiagnosis of Bacterial Infections Microscopy & StainsGram staining is a very useful procedure

28、 in diagnostic microbiology. Most specimens submitted when bacterial infection is suspected should be smeared on glass slides, Gram-stained, and examined microscopically. 第二十五張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseDiagnosis of Bacterial Infections Microscopy & StainsThe appear

29、ance of bacteria on Gram-stained smears does not permit identification of species. Reports of gram-positive cocci in chains are suggestive of, but not definitive for, streptococcal species; gram-positive cocci in clusters suggest a staphylococcal species. 第二十六張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacte

30、ria that Cause DiseaseDiagnosis of Bacterial Infections Microscopy & StainsSpecimens submitted for examination for mycobacteria should be stained for acid-fast organisms, using either Ziehl-Neelsen stain or Kinyoun stain. Immunofluorescent antibody (IF) staining is useful in the identification of ma

31、ny microorganisms 第二十七張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseDiagnosis of Bacterial InfectionsCulture SystemsFor diagnostic bacteriology, it is necessary to use several types of media for routine culture, particularly when the possible organisms include aerobic, facultatively

32、anaerobic, and obligately anaerobic bacteria. 第二十八張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseDiagnosis of Bacterial InfectionsCulture Systems culture media used to diagnose : blood agar, Chocolate agar, selective medium for enteric gram-negative rods (either MacConkey agar or eosi

33、n-methylene blue EMB agar,brucella agar with hemin and vitamin K, Many other specialized media are used in diagnostic bacteriology; choices depend on the clinical diagnosis and the organism under consideration. 第二十九張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseDiagnosis of Bacterial

34、Infections Antigen DetectionImmunologic systems designed to detect antigens of microorganisms can be used in the diagnosis of specific infections. IF tests (direct and indirect fluorescent antibody tests) are one form of antigen detection and are discussed in separate sections in this chapter on the

35、 diagnosis of bacterial, chlamydial, and viral infections and in the chapters on the specific microorganisms.第三十張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseDiagnosis of Bacterial Infections Antigen DetectionEnzyme immunoassays (EIA), including enzyme-linked immunosorbent assays (EL

36、ISA), and agglutination tests are used to detect antigens of infectious agents present in clinical specimens. The principles of these tests are reviewed briefly here. 第三十一張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseDiagnosis of Bacterial Infections Antigen DetectionLatex agglutinat

37、ion tests are primarily directed at the detection of carbohydrate antigens of encapsulated microorganisms. Another form of EIA, to detect antibody, is immunoblotting (Western blot), whereby defined antigens are placed on strips of nitrocellulose paper. 第三十二張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria

38、 that Cause DiseaseBacteria Using 16S rRNAThe 16S rRNA of each species of bacteria has stable (conserved) portions of the sequence. Many copies are present in each organism. Labeled probes specific for the 16S rRNA of a species are added, and the amount of label on the double-stranded hybrid is meas

39、ured. 第三十三張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseBacteria Using 16S rRNAThis technique is widely used for the rapid identification of many organisms. Examples include the most common and important Mycobacterium species, Coccidioides immitis, Histoplasma capsulatum, and others.

40、第三十四張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseMolecular DiagnosticsThe principle behind early molecular assays is the hybridization of a characterized nucleic acid probe to a specific nucleic acid sequence in a test specimen followed by detection of the paired hybrid. 第三十五張，PPT共一

41、百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause DiseaseMolecular DiagnosticsTarget Amplification Systems transcription-mediated amplification (TMA)the nucleic acid sequence-based amplification (NASBA) Strand displacement assays (SDA) Probe Amplification Systems-The ligase chain reaction (LCR ) Signa

42、l Amplification Techniques-branched DNA (bDNA) 第三十六張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Identifying Bacteria that Cause Disease第三十七張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月病毒感染性疾病 常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合 1.感染病的實(shí)驗(yàn)診斷方法雖按基本原則進(jìn)行，但 病毒感染性疾病具下述特點(diǎn)： 作分離的標(biāo)本和細(xì)菌標(biāo)本不一樣，必須是經(jīng) 濾過除菌的液體標(biāo)本。大多數(shù)病毒對(duì)熱敏感 ， 因此標(biāo)本需迅速冷藏和運(yùn)送。病毒分離培養(yǎng)后, 根據(jù)細(xì)胞病變特征確定何種病毒，再此基礎(chǔ) 上，對(duì)已分離的病毒和已知參考血清作中

43、和試 驗(yàn)、補(bǔ)體結(jié)合試驗(yàn)。 第三十八張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月病毒感染性疾病 常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合2.病毒血清學(xué)檢查 是病毒感染診斷的常規(guī)實(shí)驗(yàn)室方法，用免疫標(biāo)記技術(shù)檢測(cè)標(biāo)本組織細(xì)胞內(nèi)的病毒抗原和胞外游離病毒抗原是一種快速的早期診斷。顯微鏡檢查也是病毒實(shí)驗(yàn)診斷不可忽視的手段，光學(xué)顯微鏡檢查感染組織或脫落細(xì)胞中特征性病毒包涵體、電鏡檢查病毒顆粒是早期診斷的方法之一。第三十九張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月病毒感染性疾病 常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合3.核酸檢測(cè) 病毒分離鑒定和血清學(xué)診斷一般需較長(zhǎng)時(shí)間才能判斷結(jié)果，近年來發(fā)展的利用核酸雜交技術(shù)和PCR技術(shù)檢測(cè)標(biāo)本中病毒

44、核酸，是一種快速的早期診斷。對(duì)那些可能新出現(xiàn)的病毒，只有用分離方法取得最好診斷結(jié)果。第四十張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月病毒感染性疾病 常用實(shí)驗(yàn)室檢測(cè)項(xiàng)目的組合 4.以循證檢驗(yàn)為依據(jù)選擇實(shí)驗(yàn)項(xiàng)目 病毒感染實(shí)驗(yàn)診斷方法諸多，且各具不同的敏感度和特 異度。有關(guān)的醫(yī)學(xué)專業(yè)組織可充分利用已有的循證診斷 試驗(yàn)的文獻(xiàn)，制定科學(xué)的、嚴(yán)格的、用于臨床疾病診斷 的指南。指南根據(jù)現(xiàn)有的最佳證據(jù)或?qū)＜业囊恢乱庖姡?提供診斷建議，將實(shí)驗(yàn)室診斷試驗(yàn)項(xiàng)目分別按證據(jù)的等 級(jí)水平進(jìn)行標(biāo)記。臨床實(shí)驗(yàn)室人員、特別是臨床醫(yī)師可 依據(jù)指南對(duì)同一組織器官、不同病毒感染或不同組織器 官、同一病毒感染選擇最佳。第四十一張，

45、PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月approaches to the diagnosis of viral infectionThere are two major approaches to the diagnosis of viral infection: virologic and serologic. The virologic approach includes (1) isolation of infectious virus in cell culture or in laboratory animals, (2)detection of viral antigenby

46、immunologic methods such as immunofluorescence assay (IFA) or enzyme immunoassay (EIA), (3) identification of viral particlesby electron microscopy (EM), and (4) detection of viral nucleic acid. 第四十二張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月approaches to the diagnosis of viral infectionThe serologic approach includes

47、(1)demonstration of a fourfold or greater rise in antiviral antibody using acute and convalescent sera and a variety of methods that measure predominantly immunoglobulin (Ig) antibody and (2)demonstration of virus-specific IgM antibody in a single late acute or recovery phase serum.第四十三張，PPT共一百三十二頁(yè)，

48、創(chuàng)作于2022年6月approaches to the diagnosis of viral infectionAs is true for any diagnostic test, the timing, quality, and handling of the specimen are critical for an accurate diagnosis. For the virologic approach to diagnosis, it is important to obtain specimens during the acute infection from the site

49、of disease. 第四十四張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月approaches to the diagnosis of viral infectionOptimal Specimens The optimal specimens vary depending on the site of disease： 1、Lesions 2、Pediatric Respiratory Illness 3、Adult Respiratory Illness4、Acute Infection第四十五張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月 approaches to the diag

50、nosis of viral infection- Viral IsolationIsolation of infectious virus in tissue cell cultures remains one of the most commonly used methods to detect viruses. The major viruses detected by isolation in cell culture include HSV,CMV,RSV, influenza A and B ,the parainfluenza viruses, the adenoviruses,

51、 the enteroviruses (Coxsackie A and B,echo, polio), and VZV. 第四十六張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月 approaches to the diagnosis of viral infection- Viral IsolationSeveral Different Types of Cells Because not all culturable viruses will grow in a single cell line, several different types of cells are required:

52、(1)During the winter season, the cells that may be used to isolate respiratory viruses include primary rhesus monkey kidney. Madin-Darby canine kidney, Hep-2(a human epithelial carcinoma cell line,) buffalo green monkey kidney continuous cell line, and a human fibroblast cell. 第四十七張，PPT共一百三十二頁(yè)，創(chuàng)作于20

53、22年6月 approaches to the diagnosis of viral infection- Viral IsolationSeveral Different Types of Cells (2) For the summer/fall enterovious season,these are different from the cells used: primary rhesus monkey kidney, Hep-2, buffalo green monkey kidney, RD(a human rhabdomyosarcoma cell line),and a hum

54、an fibroblast cell. 第四十八張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月approaches to the diagnosis of viral infection -Viral Isolation(3)Cytopathic Effect (CPE) 1.Many viruses will demonstrate a cytopathic effect (CPE) within a few days, whereas some may take as long as a week or two . Some viruses will do not cause typica

55、l CPE and are identified by the adsorption of red blood cells to the surface of virus-infected cells in the culture (e.g hemadsorption for the influenza and parainfluenza viruses). For some viruses, such as several of the Coxsackie A viruses and Colorado tick fever virus mouse inoculation is require

56、d. 第四十九張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月Cytopathic Effect (CPE)第五十張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月 hemadsorption for the influenza and parainfluenza viruses第五十一張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月mouse inoculation 第五十二張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月approaches to the diagnosis of viral infection -Viral IsolationCytopathic Effect (CPE) 2.Wi

57、th cell culture systems, presumptive identification of particular virus or virus group(e.g. HSV or RSV or an enterovirus)can be performed within a few or several days based on the CPE: characteristics, time of onset ,and cell type in which it occurs. This presumptive identification can be greatly fa

58、cilitated if the test requisition slip contains the important information requested: source of the specimen (e.g. swab of a genital ulcer or a conjunctival swab rather than an unidentified swab source ) and clinical diagnosis(e.g. genital herpes, influenza, aseptic meningitis).第五十三張，PPT共一百三十二頁(yè)，創(chuàng)作于20

59、22年6月approaches to the diagnosis of viral infection -Viral IsolationConfirmation of a Specific Virus Confirmation of a specific virus serotype or of a virus (e.g.HSV-2, influenza A H3N2, echovirus11)requires use of immunologic methods with antibody of known specificity. In recent years, fluorescence

60、 or peroxidase-conjugated monoclonal antibodies(MABs)have become available commercially to detect viral antigen in cell cultures, e.g. HSV, CMV, VZV, RSV, influenza A and B, the parainfluenza viruses, and the adenoviruses. 第五十四張，PPT共一百三十二頁(yè)，創(chuàng)作于2022年6月approaches to the diagnosis of viral infection -Vi