复旦大学：《医学微生物学 Medical Microbiology》理论教学课件_肠杆菌科（Enterobacteriaceae）——埃希菌属 Esherichia、变形杆菌属

埃希菌属 (Esherichia) 埃希菌属有6个种,其中大肠埃希 菌( Escherichia coli)是最常见的临 床分离菌。 2016/5/5 E. coli-Jungi's Lecture

2016/5/5 E.coli-Junqi's Lecture 1 埃希菌属 (Esherichia) 埃希菌属有6个种，其中大肠埃希 菌（Escherichia coli） 是最常见的临 床分离菌

大肠埃希菌(E.cOli) 正常菌群:拮抗致病菌的定居增殖 产生ⅤitB,ⅤitK 条件致病菌:机体抵抗力下降 细菌移出肠外 菌群失调 食品与水源被粪便污染的检测指标: 饮用水:<3/1L;汽水、果汁:<5/100ml 四、分子生物学研究的重要实验材料: 载体菌,提供内切酶 五、所致疾病 2016/5/5 E. coli-Junqi's Lecture

2016/5/5 E.coli-Junqi's Lecture 2 大肠埃希菌（E. coli） 一、正常菌群：拮抗致病菌的定居增殖 产生Vit B, Vit K 二、条件致病菌：机体抵抗力下降 细菌移出肠外 菌群失调 三、食品与水源被粪便污染的检测指标： 饮用水: < 3 / 1L; 汽水、果汁: < 5 / 100ml 四、分子生物学研究的重要实验材料： 载体菌，提供内切酶。 五、所致疾病

Case Report 21-vear old woman presented to the universi student health service with a 2-day history of increasing urinary frequency(尿频) along with urgency(尿急) and dysuria(小便困难 尿痛). Her urine had been pink or bloody for about 12 hours. She had no history of prior urinary tract infection. The patient had recently become sexually active and was using a diaphragm and spermicide 2016/5/5 E. coli-Junqi's Lecture

2016/5/5 E.coli-Junqi's Lecture 3 Case Report 21-year old woman presented to the university student health service with a 2-day history of increasing urinary frequency（尿频） along with urgency（尿急） and dysuria（小便困难， 尿痛）. Her urine had been pink or bloody for about 12 hours. She had no history of prior urinary tract infection. The patient had recently become sexually active and was using a diaphragm and spermicide

Clinical Features The temperature was 37.5C, pulse 105/min, and respirations 18/min. The blood pressure was l05/70mmHg On physical examination, the only abnormal finding was mild tenderness to deep palpation in the suprapubic area 2016/5/5 E. coli-Jungi's Lecture

2016/5/5 E.coli-Junqi's Lecture 4 Clinical Features The temperature was 37.5℃，pulse 105/min, and respirations 18/min. The blood pressure was 105/70mmHg. On physical examination, the only abnormal finding was mild tenderness to deep palpation in the suprapubic area

Laboratory findings Lab tests showed a slightly elevated white blood cell count of 13, 000/ul; 66%% were PMNs, also elevated.. Culture yielded more than 105 colony-forming units(CFU/ml) of E coli (diagnostic of a urinary tract infection) Antimicrobial susceptibility tests were not done Treatment The patient was cured by 3 days of oral sulfamethoxazole-trimethoprim therapy. 2016/5/5 E. coli-Junqi's Lecture

2016/5/5 E.coli-Junqi's Lecture 5 Laboratory Findings Lab tests showed a slightly elevated white blood cell count of 13,000/ul; 66% were PMNs, also elevated….Culture yielded more than 105 colony-forming units (CFU/ml) of E.coli (diagnostic of a urinary tract infection). Antimicrobial susceptibility tests were not done. Treatment The patient was cured by 3 days of oral sulfamethoxazole-trimethoprim therapy

Comments "honeymoon cystitis" Urinary tract infections may involve just the lower tract or both the lower and upper tracts. Cystitis is the term used to describe the infection of the bladder with signs and symptoms including dysuria, urgency and frequency, as in this case The prevalence of bacteriuria is 1-2%o in school-age girls, 1-3%o in nonpregnant women, and 3-8%during pregnancy. The prevalence of bacteriuria increases with age, and the sex ratio of infections becomes nearly equal. Over the age of 70 years, 20-30% or more women and 10% or more of men have bacteriuria Upper urinary tract infections routinely occur in patients with indwelling catheters even with optimal care and closed drainage systems: 50%0 after 4-5 days, 75%o after 7-9 days, and 100% after 2 weeks. Sexual activity and use of spermicides increase the risk of infection in young women E Coli causes 80-90% of acute uncomplicated bacterial lower tract infections in young women 2016/5/5 E. coli-Junqi's Lecture

2016/5/5 E.coli-Junqi's Lecture 6 Comments Urinary tract infections may involve just the lower tract or both the lower and upper tracts. Cystitis is the term used to describe the infection of the bladder with signs and symptoms including dysuria, urgency and frequency, as in this case. The prevalence of bacteriuria is 1-2% in school-age girls, 1-3% in nonpregmant women, and 3-8% during pregnancy. The prevalence of bacteriuria increases with age, and the sex ratio of infections becomes nearly equal. Over the age of 70 years, 20-30% or more women and 10% or more of men have bacteriuria. Upper urinary tract infections routinely occur in patients with indwelling catheters even with optimal care and closed drainage systems: 50% after 4-5 days, 75% after 7-9 days, and 100% after 2 weeks. Sexual activity and use of spermicides increase the risk of infection in young women. E.Coli causes 80-90% of acute uncomplicated bacterial lower tract infections in young women. "honeymoon cystitis

泌尿系统感染:尿道炎 膀胱炎 肠外感染 肾盂肾炎 Ureter Uterus 败血症 婴儿脑膜炎 肠内感染胃肠炎 由致病性大肠埃希菌引起 Extremely common world widely Affecting human at all ages Sometimes cause blood diarrhea 2016/5/5 E. coli-Jungi's Lecture

2016/5/5 E.coli-Junqi's Lecture 7 泌尿系统感染：尿道炎 膀胱炎 肾盂肾炎 肠内感染——胃肠炎 由致病性大肠埃希菌引起 败血症 婴儿脑膜炎 肠外感染 Extremely common world widely Affecting human at all ages Sometimes cause blood diarrhea

致病性大肠埃希菌 肠产毒性大肠埃希菌 Enterotoxigenic E coli, ETEC) 肠侵袭性大肠埃希菌 Enteroinvasive E coli, EIEC) 肠致病性大肠埃希菌 (enteropathogenic E coli, EPEC) 肠出血性大肠埃希菌 (enterohemorrhagic E coli, EHEC) 肠集聚性大肠埃希菌 (enteroaggregative E coli, EAEC, EAggEC) 2016/5/5 E. coli-Junqi's Lecture

2016/5/5 E.coli-Junqi's Lecture 8 致病性大肠埃希菌  肠产毒性大肠埃希菌 （enterotoxigenic E.coli , ETEC）  肠侵袭性大肠埃希菌 （enteroinvasive E.coli , EIEC）  肠致病性大肠埃希菌 （enteropathogenic E.coli , EPEC）  肠出血性大肠埃希菌 （enterohemorrhagic E.coli ,EHEC）  肠集聚性大肠埃希菌 （enteroaggregative E.coli , EAEC, EAggEC）

致泻性大肠埃希菌 大肠埃希菌作用部位所致疾病作用机理 ETEC 小肠 旅行者、幼儿水泻质粒编码的毒素 LT、ST EIEC 大肠 成人、儿童菌痢样质粒编码的侵袭 腹泻 性蛋白介导的侵 袭性粘附 EPEC 小肠 婴儿腹泻 质粒编码的菌毛 介导的侵袭性粘 附 EHEC 大肠 出血性结肠炎、尿噬菌体编码的志 毒症 贺样毒素(SLT EAEC 肠 婴儿水泻 质粒编码的菌毛介 导的凝聚性粘附 2016/5/5 E. coli-Jungi's Lecture

2016/5/5 E.coli-Junqi's Lecture 9 致泻性大肠埃希菌 大肠埃希菌 作用部位 所致疾病 作用机理 ETEC 小肠 旅行者、幼儿水泻 质粒编码的毒素 LT、ST EIEC 大肠 成人、儿童菌痢样 腹泻 质粒编码的侵袭 性蛋白介导的侵 袭性粘附 EPEC 小肠 婴儿腹泻 质粒编码的菌毛 介导的侵袭性粘 附 EHEC 大肠 出血性结肠炎、尿 毒症 噬菌体编码的志 贺样毒素(SLT) EAEC 小肠 婴儿水泻 质粒编码的菌毛介 导的凝聚性粘附

肠致病性大肠埃希菌 (EPEC) ■最早发现引起腹泻的大肠埃希菌 不产生肠毒素和其他外毒素 ■粘附于徼绒毛,在黏膜表面大量繁殖, 导致刷状缘破坏,微绒毛萎缩,上皮细 胞排列紊乱和功能受损,造成严重腹泻。 2016/5/5 E. coli-Jungi's Lecture

2016/5/5 E.coli-Junqi's Lecture 10  最早发现引起腹泻的大肠埃希菌  不产生肠毒素和其他外毒素  粘附于微绒毛，在黏膜表面大量繁殖， 导致刷状缘破坏，微绒毛萎缩，上皮细 胞排列紊乱和功能受损，造成严重腹泻。 肠致病性大肠埃希菌 （EPEC）