醫(yī)學(xué)微生物學(xué)課件-資料下載頁(yè)
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【正文】 e considered for patients with chronic active hepatitis. The response rate is around 50% but 50% of responders will relapse upon withdrawal of treatment. ? Ribavirin there is less experience with ribavirin than interferon. However, recent studies suggest that a bination of interferon and ribavirin is more effective than interferon alone. Hepatitis D virus ? δ肝炎病毒（ Hepatitis δ virus） ? 從 HBV感染者中發(fā)現(xiàn)的 HDV Prevalence High Intermediate Low Very Low No Data Taiwan Pacific Islands Geographic Distribution of HDV Infection 生物學(xué)性狀 ? 35～ 37nm，球形顆粒 ? 環(huán)狀單股負(fù)鏈 RNA和 HDAg（即 δ抗原） ? ? 表面為 HBV包膜蛋白（ HBsAg） HBsAg RNA d antigen ? HDV為缺陷病毒 ? 不能獨(dú)立進(jìn)行復(fù)制，必須在 HBV或其它嗜肝 DNA病毒輔助才能增殖 ? 敏感動(dòng)物黑猩猩，土撥鼠和北京鴨等 Hepatitis D Clinical Features ? Coinfection ? severe acute disease ? low risk of chronic infection ? Superinfection ? usually develop chronic HDV infection ? high risk of severe chronic liver disease ? may present as an acute hepatitis HDV Transmission ? Percutanous exposures ? injecting drug use ? Permucosal exposures ? sex contact 免疫性 ? 抗 HDV 不能清除病毒，為診斷指標(biāo) ? HDV IgM和 IgG持續(xù)存在，提示為 HDV慢性感染 Time after Exposure Titer antiHBs Symptoms ALT Elevated Total antiHDV IgM antiHDV HDV RNA HBsAg Serological Course of Acute HDV infection Time after Exposure Titer Jaundice Symptoms ALT Total antiHDV IgM antiHDV HDV RNA HBsAg Serological Course of HDV superinfection 微生物學(xué)檢查法 ? 血清學(xué)方法 ? ELISA檢查 HDAg或抗 HDV ? HDAg在急性期可陽(yáng)性，檢出率低 ? 慢性感染檢不到 ? 核酸分子雜交法 ? HBVHDV Coinfection Pre or postexposure prophylaxis to prevent HBV infection. ? HBVHDV Superinfection Education to reduce risk behaviors among persons with chronic HBV infection. Hepatitis D Prevention Hepatitis E virus， HEV ? 戊型肝炎病毒 ? 經(jīng)腸道傳播的非甲非乙型肝炎病毒 ? 疾病：戊型肝炎 Geographic Distribution of Hepatitis E 生物學(xué)性狀 ? HEV呈球形，直徑 27～ 38nm ? 核酸為線形（ ） ssRNA ? 無包膜， 20面體立體對(duì)稱 ? 現(xiàn)分類于杯狀病毒 ? 只有一個(gè)血清型 ? 易感動(dòng)物 ? 非洲綠猴、恒河猴、黑猩猩 致病性 ? 糞－口途徑傳播 ? 水源污染造成流行，極小生活接觸導(dǎo)致感染 ? 多感染 20— 40歲成人 ? 潛伏期 2— 9周，臨床表現(xiàn)為急性肝炎， 6周即恢復(fù) ? 少數(shù)重癥死亡。無慢性感染病例 ? 致病機(jī)理不明 ? 免疫損傷是主要機(jī)制。病后有一定免疫力 Weeks after Exposure Titer Symptoms ALT IgG antiHEV IgM antiHEV Virus in stool 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Serological Course of HEV infection 微生物學(xué)檢查法 ? 免疫電鏡 ? 血清學(xué)方法，檢測(cè)抗 HEV ? HEV核酸檢測(cè) Prevention and Control Measures for Travelers to HEVEndemic Regions ? Avoid drinking water (and beverages with ice) of unknown purity, uncooked shellfish, and uncooked fruit/vegetables not peeled or prepared by traveler. ? IG prepared from donors in Western countries does not prevent infection. ? Unknown efficacy of IG prepared from donors in endemic areas. ? Vaccine? 庚型肝炎病毒 ? 1995年發(fā)現(xiàn) ? 屬黃病毒科 ? 核酸為 +ssRNA， ，編碼一個(gè) ORF ? 黑猩猩易感 ? 感染世界分布 ? 經(jīng)血或腸道外傳播、垂直傳播和性傳播 ? 臨床感染 ? 急性和慢性過程 ? HGV常與 HCV重疊感染 ? 診斷 ? 血清學(xué)方法或 PCR ? HGV是否嗜肝仍不清楚 ? 與疾病關(guān)系必須將 HBV、 HDV、 HCV感染排除后才可確認(rèn) Source of virus feces blood/ bloodderived body fluids blood/ bloodderived body fluids blood/ bloodderived body fluids feces Route of transmission fecaloral percutaneous permucosal percutaneous permucosal percutaneous permucosal fecaloral Chronic infection no yes yes yes no Prevention pre/post exposure immunization pre/post exposure immunization blood donor screening。 risk behavior modification pre/post exposure immunization。 risk behavior modification ensure safe drinking water Summary: Type of Hepatitis A B C D E Question ? Compare HAV and HBV according to the following criteria: classification, genome, presence of envelope, clinical features, and transmissions. ? What are the three important antigens in the HBV particle? ? Why is the delta agent found only in persons infected with HBV? 謝謝觀看 /歡迎下載 BY FAITH I MEAN A VISION OF GOOD ONE CHERISHES AND THE ENTHUSIASM THAT PUSHES ONE TO SEEK ITS FULFILLMENT REGARDLESS OF OBSTACLES. BY FAITH I BY FAITH
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