雙語細菌的感染與免疫

BasictermsBacterialinfection（細菌的感染）Pathogen（病原菌）Nonpathogen（非病原菌）Opportunisticpathogen（機會致病菌）目前一頁\總數(shù)六十八頁\編于十五點BacterialInfection細菌的感染Theprocessofbacteriainvadinginthebody,growinginthetissues,producingtoxinsandcausingdiseasesiscalledbacterialinfection.目前二頁\總數(shù)六十八頁\編于十五點Pathogen（病原菌）Pathogenicbacterium（致病菌）Abacteriumwhichcancauseadiseaseiscalledpathogen.Nonpathogen（非病原菌）Nonpathogenicbacterium（非致病菌）Abacteriumthatdoesnotcausediseaseiscallednonpathogen.目前三頁\總數(shù)六十八頁\編于十五點Opportunisticpathogen（機會致病菌）Conditionedpathogen（條件致病菌）Somebacteriaarecapableofcausingdiseasesonlyundercertainconditions.Theseorganismscancausediseaseonlyifoneormoreoftheusualdefencemechanismshumanshaveevolvedtorestrictmicroorganismsfromtheirusuallysterileinternalorgansandtissuearebreachedbyaccident,byintent(e.g.surgery),orbyanunderlyingmetabolicoraninfectiousdisorder(e.g.AIDS).目前四頁\總數(shù)六十八頁\編于十五點OutlineNormalfloraandopportunisticpathogenBacterialpathogenesisThehostimmunedefencesystemTheinitiationandcourseofinfectionHospitalinfection目前五頁\總數(shù)六十八頁\編于十五點Section1

Normalfloraandopportunisticpathogen

正常菌群與機會致病菌目前六頁\總數(shù)六十八頁\編于十五點★Normalflora（正常菌群）Normalmicrobialflora（正常微生物群）Thepopulationofmicroorganismsthatinhabittheskinandmucousmembranesofhealthypersons.Theyareusuallyharmless,someevenbeneficial,tohuman’shealth.目前七頁\總數(shù)六十八頁\編于十五點LocationsSurfacetissuesofskinOralcavityRespiratorytractGastrointestinaltractGenitourinarytract目前八頁\總數(shù)六十八頁\編于十五點Normalfloraonintestinalmucosa目前九頁\總數(shù)六十八頁\編于十五點腸道的正常菌群目前十頁\總數(shù)六十八頁\編于十五點目前十一頁\總數(shù)六十八頁\編于十五點★BeneficialeffectsofthenormalfloraBiologicalantagonism（生物拮抗）Productionofessentialnutrients（營養(yǎng)作用）Primingofimmunesystem（免疫作用）Anti-aging（抗衰老作用）目前十二頁\總數(shù)六十八頁\編于十五點Biologicalantagonism(生物拮抗)Biologicalbarriers（生物屏障）orReceptorcompetition（受體競爭)Harmfulmetabolites（有害代謝產(chǎn)物）Nutrientcompetition（營養(yǎng)競爭）目前十三頁\總數(shù)六十八頁\編于十五點Conditionedpathogen（條件致病菌）Somebacteriaarecapableofcausingdiseasesonlyundercertainconditions.Thesebacteriaarecalledopportunistic(conditioned)pathogensandthiskindofinfectioniscalledopportunisticinfection（機會性感染）.★

Opportunisticpathogen（機會致病菌）目前十四頁\總數(shù)六十八頁\編于十五點★

ConditionsofopportunisticinfectionChangeofinhabitingplaces（寄居部位改變）Immunesystemcompromise（宿主免疫功能低下）Dysbacteriosis（菌群失調(diào)）目前十五頁\總數(shù)六十八頁\編于十五點Dysbacteriosis（菌群失調(diào)）Iffloradisequilibriumoccurs,forexample,whentheresidentfloraisdisturbed,somelittlesignificantmicroorganismsmaycolonize,proliferate,andproducedisease,whichiscalleddysbacteriosis.Dysbacteriosismainlyresultedfromlongtermandlargedosesantibioticstaken.目前十六頁\總數(shù)六十八頁\編于十五點Superinfection（重疊感染）Afrequentcomplicationofdrugtherapyformicrobialinfection.Itmayresultfromopportunisticcolonizationfollowingimmunosuppressionbytheprimarypathogenandcanbeinfluencedbythetimeintervalbetweeninfections,microbialphysiology,orhostresistance.目前十七頁\總數(shù)六十八頁\編于十五點Dysbacteriosisandsuperinfection目前十八頁\總數(shù)六十八頁\編于十五點腸道的正常菌群健康青壯年糞便涂片健康老年糞便涂片（雙歧桿菌）目前十九頁\總數(shù)六十八頁\編于十五點Probiotics（益生菌）目前二十頁\總數(shù)六十八頁\編于十五點Probiotics（益生菌）&Prebiotics（益生元）目前二十一頁\總數(shù)六十八頁\編于十五點Section2

BacterialPathogenesis

細菌的致病作用BasictermsBacterialPathogenicity

BacterialvirulenceNumberofinvadingorganismsPortalofentry目前二十二頁\總數(shù)六十八頁\編于十五點Pathogenicity（致病性）

isusedtodescribethecapacityofbacteriatoinitiatediseases.Thetermofvirulence（毒力）

isusedasacomparisonofpathogenicityinthequantitativesense.ID50（medianinfectiousdose,半數(shù)感染量）:Infectiousdoseofbacteriafor50%ofthetestpopulation.LD50

（medianlethaldose,半數(shù)致死量）

:Lethaldoseofbacteriafor50%ofthetestpopulation.BasicTerms目前二十三頁\總數(shù)六十八頁\編于十五點ExotoxinPili(Fimbrial)CapsuleVirulentEnzymeAdhesinsFlagellaIronbindingproteinVirulencesurfaceproteinBacterialvirulencefactors（細菌毒力因子）目前二十四頁\總數(shù)六十八頁\編于十五點Bacterialvirulence（細菌的毒力）Virulence（毒力）Invasiveness（侵襲力）Toxin（毒素）Adherence&permanentplanting（黏附與定植）Multiplication&diffusion（增殖與擴散）Anti-defensefunctionofhost（免疫逃逸）Endotoxin（內(nèi)毒素）Exotoxin（外毒素）目前二十五頁\總數(shù)六十八頁\編于十五點Adhesionandfieldplanting（黏附與定植）Invasion（侵入）Multiplicationanddiffusion（繁殖與擴散）Localdiffusion（局部擴散）Systemicdiffusion（全身性擴散）目前二十六頁\總數(shù)六十八頁\編于十五點★Invasiveness（侵襲力）Definition:Bacterialcapabilitythatcanbreakthroughthephysiologicbarriers(skin,mucosa),settledown,multiply,andspreadinthehost.Adhesivefactors:adhesinandcapsuleInvasivesubstancesBacterialbiofilm目前二十七頁\總數(shù)六十八頁\編于十五點1.Adhesin（黏附素）Protiensonbacterialsurfaceassociatedwithadhesion.Adhesinsbindtoadhesinreceptorsonhostcells.Classification:Pilus(fimbriae)adhesin(菌毛黏附素)Non-fimbriaeadhesin(非菌毛黏附素)目前二十八頁\總數(shù)六十八頁\編于十五點AdhesinAdhesinEpitheliumReceptorBacterium目前二十九頁\總數(shù)六十八頁\編于十五點Capsule(莢膜)ofstreptococcuspneumoniaeMicrocapsule（微莢膜）

Slimelayer（黏液層）目前三十頁\總數(shù)六十八頁\編于十五點ProtectthecellwallagainstattackbydrugsInhibitingestionandkillingbyphagocytesPlayaroleintheadherenceofhumantissueAntigenicity2.Capsule（莢膜）目前三十一頁\總數(shù)六十八頁\編于十五點3.Invasiveenzymes侵襲性酶類Somebacteriamaygenerateinvasiveenzymes,whichcandamagebodytissuesandpromotetheinvasionanddiffusionofthebacteria.目前三十二頁\總數(shù)六十八頁\編于十五點4.Invasin侵襲素Encodedbyinvasivegenes（侵襲基因）Mediateinvadingadjacentepithelialcells目前三十三頁\總數(shù)六十八頁\編于十五點5.Bacterialbiofilm細菌生物被膜：Themembraneousbacterialcommunitycomposedofbacteriaandtheextracellularpolymerssecretedbybacteriaaftertheyadheretothesurfaceoflivingornonlivingmaterials.目前三十四頁\總數(shù)六十八頁\編于十五點5.Bacterialbiofilm細菌生物被膜FacilitatesbacterialadhesionBafflesthepenetrationofantibioticandtherejectionofimmunesystemProfitssignalcommunicationamongbacteria.目前三十五頁\總數(shù)六十八頁\編于十五點Bacterialbiofilm目前三十六頁\總數(shù)六十八頁\編于十五點目前三十七頁\總數(shù)六十八頁\編于十五點Biofilmintheendoscope（內(nèi)窺鏡）目前三十八頁\總數(shù)六十八頁\編于十五點Staphylococcusepidermidis（表皮葡萄球菌）biofilminthesurfaceofvenouscatheter（靜脈導管）目前三十九頁\總數(shù)六十八頁\編于十五點ExotoxinsEndotoxinsExcretedbylivingcells;highconcentrationsinliquidmedium.IntegralpartofthecellwallofG-bacteria.Releasedonbacterialdeathandinpartduringgrowth.Maynotneedtobereleasedtohavebiologicactivity.ProducedbybothG+andG-bacteria.FoundonlyinG-bacteria.PolypeptidesLPS(lipidAportionprobablyresponsiblefortoxicity.)Relativelyunstable;toxicityoftendestroyedrapidlybyheatingattemperaturesabove60℃.Relativelystable;withstandheatingattemperaturesabove60℃forhourswithoutlossoftoxicity.目前四十頁\總數(shù)六十八頁\編于十五點ExotoxinsEndotoxinsHighlyantigenic;stimulateformationofhigh-titerantitoxin(抗毒素).Antitoxinneutralizestoxin.Weaklyimmunogenic;antibodiesareantitoxicandprotective.Relationshipbetweenantibodytitersandprotectionfromdiseaseislessclearthanwithexotoxins.Convertedtoantigenic,nontoxictoxoids(類毒素)byformalin,acid,heat,etc.Toxoidsareusedtoimmunize.Notconvertedtotoxoids.Highlytoxic;fataltoanimalsinmicrogramquantitiesorless.Moderatelytoxic;fatalforanimalsintenstohundredsofmicrograms.目前四十一頁\總數(shù)六十八頁\編于十五點ExotoxinsEndotoxinsUsuallybindtospecificreceptorsoncells.Specificreceptorsnotfoundoncells.Usuallydonotproducefeverinthehost.Selectivetoxicityandspecificclinicalsyndromes.Neurotoxins(神經(jīng)毒素)Cytotoxins(細胞毒素)Enterotoxins(腸毒素)UsuallyproducefeverinthehostbyreleaseofIL-1andothermediators.Frequentlycontrolledbyextrachromosomalgenes(e.g.plasmids).Synthesisdirectedbychromosomalgenes.目前四十二頁\總數(shù)六十八頁\編于十五點區(qū)別要點外毒素內(nèi)毒素來源革蘭陽性菌與部分革蘭陰性菌革蘭陰性菌編碼基因質(zhì)粒、前噬菌體或染色體基因染色體基因存在部分從活菌分泌出，少數(shù)菌崩解后釋出細胞壁組分，菌裂解后釋出化學成分蛋白質(zhì)脂多糖穩(wěn)定性60～80℃，30分鐘破壞160℃，2～4小時破壞毒性作用強，對組織器官有選擇性毒害效應(yīng)，引起特殊的臨床表現(xiàn)較弱，各菌的毒性效應(yīng)大致相同，引起發(fā)熱、白細胞增多、微循環(huán)障礙、休克、DIC等抗原性強，刺激機體產(chǎn)生抗毒素；甲醛液處理脫毒形成類毒素弱，刺激機體產(chǎn)生的中和抗體作用弱；甲醛液不能脫毒形成類毒素目前四十三頁\總數(shù)六十八頁\編于十五點SpecificpolysaccharideLPS目前四十四頁\總數(shù)六十八頁\編于十五點Procedure目前四十五頁\總數(shù)六十八頁\編于十五點Neurotoxin（神經(jīng)毒素）Tetanustoxin（破傷風毒素）目前四十六頁\總數(shù)六十八頁\編于十五點Cytotoxins（細胞毒素）Diphtheriatoxin（白喉毒素）inhibitsproteinsynthesisinmammaliancellsandcausesnecrosisofcellsDiphtheriamembraneonthroat目前四十七頁\總數(shù)六十八頁\編于十五點Enterotoxin（腸毒素）Choleraenterotoxin目前四十八頁\總數(shù)六十八頁\編于十五點BiologicalrolesofendotoxinFever（發(fā)熱）Leukopeniaandleukocytosis（白細胞反應(yīng)）Endotoxemiaandshock（內(nèi)毒素血癥與休克）目前四十九頁\總數(shù)六十八頁\編于十五點EndotoxinActivatesmacrophagesActivatescomplementActivatesHagemanfactorIL-1,TNF,NitricoxideFeverandhypotensionC3a,C5aHypotensionEdemaCoagulationcascadeDIC目前五十頁\總數(shù)六十八頁\編于十五點Section4

theinitiationandprocessofinfectionSourcesofinfectionPathwayofbacterialentranceTypesofbacterialinfection目前五十一頁\總數(shù)六十八頁\編于十五點Exogenousinfection（外源性感染）PatientsCarriers（帶菌者）AnimalsEnodogenousinfection（內(nèi)源性感染）OpportunisticpathogensSourcesofinfection目前五十二頁\總數(shù)六十八頁\編于十五點Pathwayofpathogenentrance

RespiratoryGastrointestinalGenitalSkinandmucosaAnimalbitesBloodSexualtransmission目前五十三頁\總數(shù)六十八頁\編于十五點TypesofbacterialinfectionInapparentinfection（隱性感染）Apparentinfection（顯性感染）Carrierstate（帶菌狀態(tài)）目前五十四頁\總數(shù)六十八頁\編于十五點Inapparentinfection（隱性感染）Subclinicalinfection（亞臨床型感染）Aninfectionthathasnoobservablesymptoms.Itoccurswhenthehostimmunityispotentorthepathogenicityofthepathogenisweak.目前五十五頁\總數(shù)六十八頁\編于十五點Thetipoftheiceberg

目前五十六頁\總數(shù)六十八頁\編于十五點Apparentinfection（顯性感染）AcuteinfectionChronicinfectionLocalinfectionGeneralizedinfection★Toxemia(毒血癥)Endotoxemia(內(nèi)毒素血癥)Bacteremia(菌血癥)Septicemia(敗血癥)Pyemia(膿毒血癥)目前五十七頁\總數(shù)六十八頁\編于十五點Toxemia（毒血癥）Bacteriamutiplyatinvadinglocationanddonotenterbloodstream,buttheexotoxins（外毒素）enterbloodandcausecorrespondingtoxicsymptoms.Endotoxemia（內(nèi)毒素血癥）Gram-negativebacteriamutiplyatlocationorinbloodstream,releasealotofamountendotoxin（內(nèi)毒素）releasedfrombacterialcellrupture.目前五十八頁\總數(shù)六十八頁\編于十五點Bacteremia（菌血癥）Afterenteringblood,bacteriacirculatebutnotmultiplyintheblood.Septicemia（敗血癥）Bacteriacirculateandmultiplyintheblood,inwhichbacteriaproducetoxicproductsandcausehighswingingtypeoffeverandothertoxicsymptoms.目前五十九頁\總數(shù)六十八頁\編于十五點Pyemia（膿毒血癥）Pyogenic（化膿性）bacteriaproducesepticemiawithmultipleabscesses（膿腫）ininternalorganssuchasspleen,liverandkidneys.目前六十頁\總數(shù)六十八頁\編于十五點★

Carrierstate（帶菌狀態(tài)）Afterinapparentinfectionorapparentinfection,sometimesthepathogensarenoteliminatedintime,sothebacteriawillsurviveandmultiplyinhostatlowspeed,andbacteriaspreadintotheenvironment.Carrier（帶菌者）isimportantsourceofinfection.目前六十一頁\總數(shù)六十八頁\編于十五點HospitalinfectionDefinitionBasiccharacteristicsClassificationMicrobialecologicalcharacteristicsEpidemiologicalcha