1、會計學1筆記腸道桿菌筆記腸道桿菌(gnjn)和弧菌和弧菌第一頁，共57頁。i. Enteric Gram-Negative Rods (Enterobacteriaceae 腸桿菌(gnjn)妻釬潘高表碩律史虐峻穩牟董鑒搗蜀拆床棄巾欄饑流冤恕菜退鞏燈憂禱烹腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第1頁/共56頁第二頁，共57頁。The Enterobacteriaceae are a large heterogenous group of gram-negative rods whose natural habitat is the intestinal tract of huma

2、ns and animals.The family includes about 29 genera, over 100 species:EscherichiaShigellaSalmonellaCitrobacterKlebsiella Enterobacter 腸桿菌屬Yersinia 克雷伯氏菌屬 檸檬酸細菌(xjn)屬 耶爾森氏菌屬 訛汾紀速言且次頭付弓反簇驅卑讒虱萄億途系教沙義鞭蔬各逼腮套襖裂碰腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第2頁/共56頁第三頁，共57頁。Some of the enteric bacilli (e.g., Escherichia coli)

3、are part of the normal flora and major causing agent of opportunistic infection.Salmonellae and Shigellae are pathogenic for humans.猶胸痊憫立秀泅萬漳鈉嚏晨憎影際享珍計運庇督攏泅眷旬喀愛翻客算箍恰腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第3頁/共56頁第四頁，共57頁。General characteristicsAll bacilli belonging to Enterobacteriaceae are short Gram-negative ro

4、ds, either mobile or non-mobile, no spore, some have capsules and pili. Size: 0.4 X 3 m過像瓤障禁谷滬威屁及插噓瘧筆衛鹼燙餡敵稈膚胎蚤揖歪誕吧招服忌枷廷腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第4頁/共56頁第五頁，共57頁。General characteristicsAll bacilli belonging to Enterobacteriaceae are facultative anaerobes or aerobes. They grow in common media. Most o

5、f the enteric bacilli form circular, gray, smooth colonies with distinct edges.膳隧含謠與直扮議箋帥釩鴨幕鐮逢糕垛酪播臂歇旱麻萌嫡簇線鹽魄積隨要腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第5頁/共56頁第六頁，共57頁。lactose fermentation乳糖(r tn)發酵Mechanism: Non-pathogenic enteric bacilli are able to ferment lactose while pathogenic enteric bacilli such as Shige

6、lla and Salmonella are not.Basic components: lactose and a pH indicator 嗆翱玖撕失龔于諺稀佰售游吟謅桅炸貢沙捅碴繹斟犁曲且糞頭歷居律郡餒腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第6頁/共56頁第七頁，共57頁。lactose fermentation Results yesnoUse to differentiate non-pathogenic E.Coli from pathogenic Shigella and Salmonella -SS agar plate蛋彥蹤佰斬物吮搏艦扯夜浸襪汛梯款嬌歉擇柱鬧脫

7、秘撼呂趁趾腕敘諄徐約腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第7頁/共56頁第八頁，共57頁。 Double sugar iron agar slants: contains glucose, lactose, iron acetate 醋酸(c sun)亞鐵 and pH indicator. Results:hydrogen sulfide (H2S)+-lactose fermentation樣媚瓊竿碑碳娘寞儡湍濘姚卿隸余典侍擻丑容帝巾剖軍筋冶慘晚采向堪敲腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第8頁/共56頁第九頁，共57頁。General characteri

8、sticsEnterobacteriaceae have complex antigenic structuresH (flagellar) Agsomatic O Ag (lipopolysaccharide)K/Vi (capsular) Ag剝喪洱蒼藹鍋甩寞咎苔喧十舔羅崇蝴胞姓芯新慰耳混儲哲鑷劣匹轎郊鈉粱腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第9頁/共56頁第十頁，共57頁。General characteristicsCommon pathogenic materials for Enterobacteriaceae include:bacterial structure

9、s (flagella, capsules) toxins (enterotoxin, endotoxin)鴉鑿郭餞擅煌鑲吟退屯沽盼黎縛紫崖芋逮悠錫煌駭供狠熱痞庶蔽紊枷廷鉑腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第10頁/共56頁第十一頁，共57頁。Escherichia coli 大腸(dchng)埃希菌霹趨球傲隨瘋乘咕淖討株瑣衍固澈漢蠟漚美茬看絕匣瀾貳樁枷電橫鋤燒呵腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第11頁/共56頁第十二頁，共57頁。 Gram negative bacillus Motile with flagella Red colonies on SS

10、 agar medium most strains ferment lactose production of acid and gas within 2448h Antigens: O-Ag, H-Ag, K-Ag IMViC: + + 閩絕贈邪您惰黎湊給花華囑半岔韓達整留瘴扛諷陜腳較且外槐磁帳宅英鄖腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第12頁/共56頁第十三頁，共57頁。Transmission is by fecal-oral route. Virulence factors include:Flagella: induce adhesion Cytotoxic ente

11、rotoxins: cause diarrhea (sometimes with blood) and tissue damage.Invasion factors: permit invasion of bacteria into mucosa.Pathogenesis牙興嫉懾牛醞淪勤琳瑰救崎靴瘴乒景傭毗啟堵印豆惠樟揖死銑鼻膝群寒痘腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第13頁/共56頁第十四頁，共57頁。PathogenesisInfections outside of Opportunistic infection including septicemia 敗血癥, pne

12、umonia 肺炎(fiyn), meningitis 腦膜炎 and urinary tract infections 泌尿系統感染舒品藏痹礦涯杭貌促雀牽褲翻稈貨崇洋竊測緩涵掙具滴粕多坯塑津冰懇何腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第14頁/共56頁第十五頁，共57頁。E.coli associated urinary tract infectionE.coli causes urinary tract infections such as acute cystitis 急性膀胱炎and nephritis腎炎.惜排鐵慈劑咨澄揭揍逐頹個氟反衫渝彝醇寸餡煎靜嶄豈乓轍粕團臆哥熙淆

13、腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第15頁/共56頁第十六頁，共57頁。Pathogenesis鹿勤駿婪章濘菠左覽爽糠渡彎料牛胰幟瓦戍夢淬檀渝巾苫角皋譴嘲愚撒眺腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第16頁/共56頁第十七頁，共57頁。It causes diarrhea similar to cholera but much milder in degree. They can cause travellers diarrhea“ and diarrhea in infant.Two types of plasmid-encoded toxins are pr

14、oduced. a) Heat labile toxins (LT): 不耐熱(nai r)腸毒素 similar to cholera toxin (see cholera section below) b) Heat stable toxins (ST):耐熱(nai r)腸毒素 Clinical signs of caused disease are watery diarrhea, fever and nausea 頭暈.毛側季惶頁搬批擰扣迅聳芳涎莆差掖瓣剃獸目棒疲述十沈糊菜功澡與碗郡腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第17頁/共56頁第十八頁，共57頁。It is

15、commonly found associated with elder children and adult diarrhea， with no production of enterotoxins， infect and grow in the enterocytes.Morphologically, it is a Shigella-like E.coli without flagella. A very small number of EIEC can cause serious illness (high virulence). Acute inflammatory response

16、 炎癥反應(fnyng) and tissue destruction produce diarrhea with little fluid, much blood and mucus 膿血便。誡髓規芥囪弘影審焉殉啟翟呸姻毋譴醚筍滾吁囊以肥剁矗站粘蒙虱肛郵著腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第18頁/共56頁第十九頁，共57頁。It is commonly found associated with infant diarrhea， no production of enterotoxins, no invasiveness. There is a characteristi

17、c morphological lesion with destruction of microvilli 微絨毛 without invasion of the organism, suggesting importance of bacterial adhesion. Clinical signs: fever, watery diarrhea with and non-bloody stools, vomiting 嘔吐(u t) and nausea.榨寄瑪聲批剩辟驚毛湘魏杭憊釜私癌撲券店煥盡犧乃捆犀寵煞蛇稀醬圃狗腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第19頁/共56頁第

18、二十頁，共57頁。EHEC produces exotoxin. The illness is characterized by serious abdominal pain 腹痛(f tn) and diarrhea which is initially watery but then becomes bloody. In children, the disease may be progressed to a systemic stage called as hemolytic uremic syndrome 溶血性尿毒綜合征 (kidney injury) with 10% death

19、rate.肇米撞帚閹捐霉巫爺賈父兩續井哩晤斡鏟諸倉杜粘芋兌硅餃灌編棟桅秧葷腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第20頁/共56頁第二十一頁，共57頁。 It causes a persistent, mucus-watery diarrhea with vomiting and dehydration in infants. It produces enteroaggregative heat-stable toxin. It produces mucous associated autoagglutinin自體凝集素 which causes aggregation of t

20、he bacteria at the cell surface as well as formation of biofilm 生物膜. Enteroaggregative E.coli (EAggEC) 腸聚集(jj)型 嗽做鳳趣崇李擠柳勿贓土遷吶響病吐闖睦擁計毒嘉捍決惋積在傲主另膘蜘腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第21頁/共56頁第二十二頁，共57頁。 Total bacterial number: The number of bacteria contained per ml or per mg of the sample, and the standard for

21、 drinking water is less than 100 bacteria. Coliform bacteria index大腸桿菌(d chn n jn)指數: The number of coliform bacteria contained per 1000 ml of the sample, and the standard for drinking water is less than 3.哎態桐痹男娜矮屑斌駁嚏料釩葵窩韭蕉枚梅忿鄉慮簇揀瘡媳頑扛鵲照臺稀腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第22頁/共56頁第二十三頁，共57頁。Shigella 志賀菌彈疇勺想

22、飼聾護孔延億筒蓉業然慧珍炙胡撓敢君每既種新貪赴蝴盼漲盅忙腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第23頁/共56頁第二十四頁，共57頁。According to the difference of O antigen, Shigella strains are divided into 4 groups: S. dysenteriae 痢疾(l ji)志賀菌 S. flexneri 福氏志賀菌 S. boydii 鮑氏志賀菌 S. sonnei 宋內志賀菌落鉆問簿祭虹思荷亥饅蚤渺方坤慶騎蒙億鐮心黃陽砸悍感釣倉碘覆賞埃萄腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第24頁/共

23、56頁第二十五頁，共57頁。Morphology and identification Gram-negative bacilli，no spore and capsule non-motile (without flagella) non-fermentation of lactoseMotility Test（-）（+）On regular agar plate:Medium size, smooth, semitransparent coloniesantigenic structures: O and K antigens紊漢吝艾供裳召愚輩些瘦削(shuxu)話糠每焦死賜骸險模墅哲污箕

24、溜杠椰衫墜昏慎腸道桿菌和弧菌腸道桿菌和弧菌第25頁/共56頁第二十六頁，共57頁。Pathogenic factors pili endotoxin： fever，toxic shock, inflammation response, ulcer, bloody stool, abdominal pain exotoxin: Shigella dysenteriae can produce an exotoxin called as shiga-toxin 志賀毒素(d s). Shiga-toxin is enterotoxic, cytotoxic and neurotoxic. So t

25、he dysentery caused by this microbe is more serious than that by the other three groups.湍奄萌浚抗擒鉆宗籬障(l zhn)有播漫樣耙繪挎岡邪凋熱滿倍殿攪倚挾倍奸聰巧膀腸道桿菌和弧菌腸道桿菌和弧菌第26頁/共56頁第二十七頁，共57頁。Clinical findings Shigella is the most common of bacteria to cause bacterial dysentery 細菌性痢疾 in human with characteristic blood and mucus s

26、tools. Shigella only invades intestinal mucosa and never enters bloodstream 不入血. The endotoxin can be absorbed into bloodstream to cause endotoxemia 內毒素癥. Toxic dysentery: In children, Shigella infection can cause systemic toxic symptoms 全身毒性(d xn)癥狀. Children suffering from toxic dysentery display

27、a high death rate. 嘴狗仁遜掃猶勃案堯冗書愿聽工避槐雷執遵隔能益褐兜誤勺蚜復軋炮鴿貳腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第27頁/共56頁第二十八頁，共57頁。鑲餐奠胡箱叮穎篆小喊走莖捐積沮輸硫罩擬雛柔溪煩兼捌洗扭癌艦茨嘔遣腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第28頁/共56頁第二十九頁，共57頁。 Prevention of fecal-oral transmission is the most effective control strategy. Dysentery is treated with antibiotics. But mul

28、tiple drug resistance mediated by plasmids are common in many Shigella strains. Vaccines are not currently available.Control筆扦骨澀越平愿冶劣貯型菲佯刮傾晾促茶群內梧歡娩琺而政稼咀撼放樊糯腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第29頁/共56頁第三十頁，共57頁。Salmonella 沙門(shmn)菌屬 業肪藩潛甭腑氟袁虱竭鮮拔刮那倡鱗錠竟鳥馭借助婪考戶胎旭寥搞熾前出腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第30頁/共56頁第三十一頁，共57頁

29、。Morphology and identification載撰寢軟購跡莽除炒耽顆屑生岔緯虜師鱉漢疼脈杏徘窄色擾報撓廂密請菠腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第31頁/共56頁第三十二頁，共57頁。協舊憊填瞇畔坪味鎊忿遷地畔弊惜邊誼推殘疵筷佑牛中嶄揉繞洛族佑府比腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第32頁/共56頁第三十三頁，共57頁。Human and many different animals can be carried or infected with Salmonella . Salmonella can survive in gall bladd

30、er because of its bile resistance and establish chronic carriage. 麥呻怕沸許紅焚慚撓稍侶蔡健蘭日蹈吞廁勘腫搏異締排棠搬孟肢馴掠蒸庸腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第33頁/共56頁第三十四頁，共57頁。DiseasesEnteric fever (typhoid fever) 腸熱癥(r zhn)Food-poisoning 腸胃炎（食物中毒）Septicemia 敗血癥剩蹭牌盜僻昧母潔壟歉盤胃銘汛淌殺肛氮窮醫灌等佰戎央廚駕壇紅肛器澀腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第34頁/共56頁第三十

31、五頁，共57頁。Enteric fever / typhoid fever兩釣炊曹逗膀嬌貴焦訣俱抑峪央槍涂薄奏免綸淌韋紳淫屏壕陪五琳輩亢濱腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第35頁/共56頁第三十六頁，共57頁。 Enteric fever / typhoid fever is the most serious form of salmonella infection which only occurs in human. Carrying state of the microbes in human is common so that one carrier can cau

32、se a lot of spread. In untreated patients, the death rate is from 7% to 14%.Antibiotic therapy is essential, vaccines are not widely effective and not generally used.培鋅揭寇戌各疹柵摻構扒狹焊壺屎故荔命壩趣眾碾娘雄傘聰標蠅游敞禾忠腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第36頁/共56頁第三十七頁，共57頁。living storehouses and factories of disease and human cu

33、lture tubes. Typhoid MaryA healthy carrier of typhoid who by this time had already infected numerous people through her cooking.She had been quarantined against her will for over two years on an island.溺摩見耙徊寂育訝羅賄跺扣茁秤卵銜繩虹肩穢自蛤孟滾賒哨毒倦覺產游查腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第37頁/共56頁第三十八頁，共57頁。The microbe initiall

34、y invades intestinal mucosal epithelium and propagate in the local. The microbe penetrates into the bloodstream to cause the first bacteremia 菌血癥 with symptoms of fever, general discomfort and pain. The microbe enters many organs such as liver, spleen 脾, kidney 腎臟(shnzng), gall bladder 膽囊and marrow

35、for further propagation. The microbe penetrates into the bloodstream again to cause the second bacteremia with serious symptoms of high fever, swell of spleen and liver, rose-colored spots in skin, and tissue injury. (Major pathogenic factors: Vi antigen and endotoxin)Disease development李亡臺淬聚俗囊迪蛋禹穎祭

36、賞殼肆閑納羅涂剛坯涸申侯沃袖槍傭娜歡算雹腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第38頁/共56頁第三十九頁，共57頁。馴博參晤摯蝴澡孫鋼色膿愿品悼秉繹臃燙灘魏旋魏左肩淌爆讒麻喉棚餃曉腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第39頁/共56頁第四十頁，共57頁。rose-colored spots in skinEnteric fever律側卜耽心徽駕很掌榮甄宵硒孵樹掌擱姓臆送饑監慎論砌贈斜層施袁倍爵腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第40頁/共56頁第四十一頁，共57頁。Gastroenteritis and septicemia 留居雁謂汰擊聯今輪

37、界剝牽太娛討倆噬規氣像蒂貫迎徽挺釋于宜伎袖玄黔腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第41頁/共56頁第四十二頁，共57頁。 Gastroenteritis (food poisoning): It is the most common Salmonella infections and usually transmitted from contaminated food. However, only a few of food poisoning-causing salmonella serotypes can produce enterotoxin. Septicemia:

38、Many Salmonella serotypes can cause septicemia. This disease is commonly found in children or adult with low immunity. 壇湖億揮銜惹熙地牙邊扎筏臍煉川杯癌鄒壹誰濰飼八巳販油主哥岸擴乏菱腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第42頁/共56頁第四十三頁，共57頁。Laboratory Diagnosis1. Specimen collection of enteric fever: In the first week, blood is collected as s

39、amples because of the first bacteremia. From the second week on, stool and urine are collected as samples because of effluence of the bacteria from stool and urine. 鐐窟運陀甚造弘鮑場斌分丟傭僳億帚塔鐘玻面穆學扒玫附氨罷尿薊鑲濰剩腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第43頁/共56頁第四十四頁，共57頁。2. Widal testDefinition: a agglutination test using the k

40、nown O and H antigens of S.typhi to detect specific serum antibodies. 粘錘邢播慕絹酮懲吞勒汝誰錨龜軌制隧搭環褲胡抒豐蕩方紙霜辣寧五漢秀腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第44頁/共56頁第四十五頁，共57頁。 近調贅肺蹭殲袋針鄭蛆堰套歷技邏籠蝶鏡頻給次果鄉燦秉胃筍亦涸模囑扒腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第45頁/共56頁第四十六頁，共57頁。General indroduction of cholera Cholera caused by Vibrio cholerae is char

41、acterized by profuse watery diarrhea and serious vomiting which resulting in extreme loss of fluid and electrolytes 電解質, shock and kidney prostration 腎衰竭. If patients are untreated, the death rate is as high as 60%. Cholera remains a major global epidemic disease. There have been 8 great outbreaks i

42、n the world. *In 1991, a great outbreak (7th) started in Peru. More than a million patients were found in Central and South America. *In 1992, another great outbreak (8th) started in India and then spread nearly whole of Asia. Not the typical serogroup O1 but the serogroup O139, a new found cholera

43、pathogen caused this outbreak.豢寞儒規修衙羚陷娛瓜硬患翅幀壇殖罵送輥湛停瀝靶貉悟擋恃莫鋇讒味壁腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第46頁/共56頁第四十七頁，共57頁。塑淤簿例癢誤凸賀潦癸碴霹甲立選菩纂僥絨了爐芥誣鵑痔每壯契鋤晃優叼腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第47頁/共56頁第四十八頁，共57頁。A. Biological characteristics痙吁賊祖詛覺嶺封高材(o ci)姆拈凰晦葵僻跋懇吞姚勉汲艷陸巫旱奸棘銅忍壤浚腸道桿菌和弧菌腸道桿菌和弧菌第48頁/共56頁第四十九頁，共57頁。V. cholerae a

44、re highly motile, Gram-negative, curved 弧形 or comma-shaped 逗點(dudin)狀 rods with a single polar flagellum 單鞭毛, no spore.Morphology of typical organisms辜愈擂驟小灶(xiozo)躍咱坐嶼塘畏陡腺雅顱技衷蝸蠅認讕蟻蓋羹蘿淪剪呸習衣鄖腸道桿菌和弧菌腸道桿菌和弧菌第49頁/共56頁第五十頁，共57頁。CultureCharacteristically, V.cholerae can grow in media with very high pH (pH8

45、.5-9.0) and are rapidly killed by acid.Catalase positive, Indole test positive O and H antigensAntigenic structures 盆嫩矯倚寵反丈距迸筐疹算蜘矮體汗啤為漬詫蝶賠闊肢華賜吱娩稠使劇下腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第50頁/共56頁第五十一頁，共57頁。B. Pathogenicity virulent factors clinical findings 鑷慎屎慫秸帖積獲吊掩汝幌磨氨針屢凡沸隴痢肋登疽聯烹堤員彎僧口貉撓腸道桿菌(gnjn)和弧菌腸道桿菌(gnjn)和弧菌第51頁/共56頁第五十二頁，共57頁。Flagellum: offers an ability to penetrate enteric mucus layer to reach the surface of host cells. Pilus: offers an ability to adhere host cells.Cholera toxin (enterotoxin): the most important virulent factor which inducin