1、通過呼吸道感染微生物 Main pathogenic microbes(Bacteria)Mycobacterium tuberculosis 結(jié)核分枝桿菌Streptococcus pneumoniae肺炎鏈球菌Corynebacterium diphtheriae白喉棒狀桿菌B. pertusis百日咳鮑特菌 Main pathogenic microbes(virus)Influenza virus流行性感冒病毒Varicella-Zoster virus, VZV水痘-帶狀皰疹病毒Mumps virus 腮腺炎病毒Measles virus麻疹病毒Rubella virus風(fēng)疹病毒 O

2、ther main pathogenic microbesMycoplasma pneumoniae肺炎支原體Chlamydia pneuminiae肺炎衣原體1、 Mycobacterium tuberculosisacid-fast rodscapsulate obligate aerobedoubling time about 1824h Lowenstein-Jensen mediumvariation resistance dryingacids and alkaliesdyes (malachite green)sensitive moist heat70% ethyl alcoh

3、olultraviolet light1) Biologic properties:Mycobacterium tuberculosis2) Pathogenicitycapsulelipidscord factor(索狀因子) , damage mitochondria membranephosphatides(磷脂), tuberculessulfatides(硫酸腦苷脂), inhibit phagosome-lysosome fusionwaxes(蠟質(zhì)D) adjuvantproteins tuberculinInfectious reservoirs patients,carrie

4、rstransmitted ways:respiratory tract 、alimentary tract、skinpulmonary tuberculosisprimary infectionsecondary infectionextra-lung infection3) Diseases causedM.Tuberculosis in lung4) Immunity infectious immunityT cell-mediated immunity immunity and hypersensitivityKoch phenomenon5) Tuberculin Testprinc

5、ipiumreagentold tuberculin, OT purified protein derivative, PPDmethodsignificanceprevention vaccination: BCG treatmentrifampin (利福平)isoniazid (異煙肼)ethambutol(乙胺丁醇)streptomycin(鏈霉素)6) prevention & treatment2、 treptococcus pneumoniaeGram-positivelancet-shaped In pairscapsulateautolysis1) Biologic prop

6、erties:Capsuleanti-phagocytic serotyping2) PathogenicityAutolysis - identificationBilepeptidoglycancell membraneteichoic acid-cholineautolysin lobar pneumonia(大葉性肺炎)particularly young and oldafter damage to upper respiratory tracte.g. following viral infectionMeningitis(children)(腦膜炎）otitis media(中耳

7、炎）3) Diseases caused3、Corynebacterium diphtheriae rod shapeGram positive metachromatic granule aerobe growth in Loefflers medium tellurite agar1) Biologic properties:Corynebacterium diphtheriaeCorynebacterium diphtheriaemetachromatic granuleDiptheria toxinB binds to host cellA inhibits protein synth

8、esis inactive elongation factor 2 coded by b-bacteriophage tox gene2) PathogenicityDiphtheriainfection upper respiratory tract (pharynx) pseudomembrane chocking bacteria do not spread systemically菌鼻咽部繁殖局部炎癥：假膜早期致死外毒素心肌炎軟腭麻痹聲嘶腎上腺功能障礙晚期致死入血3) Diseases causedThis child has diphtheria resulting in a thi

9、ck gray coating over back of throat. This coating can eventually expand down through airway and, if not treated, the child could die from suffocation CDC 4、Influenza virus type Aantigenic highly variableworldwide epidemics (eg. 1918)type Bantigenic changesomestimes epidemicstype Cantigenic stablemil

10、d illnessStructure core(-)ss RNA, separated segmentsseven（type C)or eight (type A, B) helical nucleoprotein (NP) envelope: 2 layersM1 protein: coded by virus lipid bilayer membrame: from hosthemagglutinin (HA)neuraminidase (NA) 1) Biologic properties:hemagglutinin (HA) absorption, penetrationhemaggl

11、utinationantibody to the HA protein (HIAb) neutralize the virus prevent infection neuraminidase (NA)release,spreadantibody to the NA proteinslow the spread of the virus & no protectionantigenic driftminor changes in HA or NAvariance ratio1%point mutationLimited spreadantigenic shiftmajor changes in

12、HA variance ratio:20%50%new subtypeWorldwide spreadvariation2) Pathogenesis person to person via small particle aerosols via contact infects the epithelial cells of the respiratory tractuncomplicated influenzapneumonia major causes of influenza-associated death bacterial pneumonia cardiac failurepre

13、ventionvaccine:multivalenttwo strains of influenza A and one of influenza B treatmentamantadineChinese traditional medicineIFN-alfa3) prevention & treatment5、Mycoplasmal pneumoniaeprimary atypical pneumonia via aerosolized droplets in confined populations families, schools, army barracks in persons 5-20 years of age Laboratory DiagnosisCulture Sputum or throat washingsELISAPCRTreatmenttetracyclines 6、Chlamdia pneumoniaepathogenesis via respirato