《异型淋巴细胞I》PPT课件

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1、传染性单核细胞增多症InfectiousmononucleosisYongfuHuangChunxiaLiuThe4thClinicalMedicalCollegeofYangzhouUniversity,LaboratoryMedicineCentreofNantongRichHospital,JiangsuNantong226010,China一、概述1.定义由EB病毒引起的一种急性或亚急性淋巴细胞良性增生的传染病。Self-limitingdisorderoflymphoidtissuecausedbyinfectionwithEpsteinBarrvirus(infectio

2、usmononucleosis).Characterisedbytheappearanceofmanylargelymphoblastsinthecirculation.EB病毒（Epstein-Barrvirus，EBV）Epstein和Barr于1964年从非洲儿童恶性淋巴瘤(Burkitt’slymphoma)细胞培养中最早发现主要侵犯B细胞.EBV属疱疹病毒γ亚科，外层有囊膜,囊膜内是核衣壳，它是20面体，有160个壳粒，最内层为大分子的双链DNA。EpsteinBarrVirus(EBV):HerpesFamily–(linearDNAvirusHHV4),Surround

3、edbynucleocapsidandglycoproteinenvelope.EBV生物学性状2.InfectiousMononucleosisTransmission“TheKissingDisease”2.发病情况传染源：患者、隐性感染者传播途径:唾液传播，偶尔输血感染,器官移植，性关系。感染类型：1.初次感染幼儿潜伏感染（隐性感染）多见。2.青春期原发性感染50%引起传染性单核细胞增多症（增殖性感染）3.非增殖性感染：潜伏感染→引起细胞转化→恶性转化传染性单核细胞增多症青春期初次感染非洲儿童恶性淋巴瘤（Burkitt瘤）发病前有重度EBV感染EBV引起细胞转化血清学证据：患

4、儿体内EBV-Ab水平高瘤组织中EBVDNA和EBNA鼻咽癌：见于我国广东，广西，湖南瘤组织中有EBV-DNA，EBNA血清中EBV抗体增高鼻咽癌治疗好转后，EBV抗体水平↓EB病毒感染所致疾病3.发病机理：唾液EB咽喉部淋巴组织病毒淋巴结良性增生B细胞T细胞自制3.InfectiousMononucleosisPathogenesisEBVinfectstheepitheliumoftheoropharynxandsalivaryglands.Lymphocytesinthetonsilarcryptsaredirectlyinfected->BLOODSTREAM.Infect

5、edBcellsandactivatedTcellsproliferateandexpand.PolyclonalBcellsproduceantibodiestohostandviralproteins.InfectiousMononucleosisPathogenesisMemoryBcells(notepithelialcells)arereservoirforEBV.EBVreceptorisCD21(foundonBcellsurface)Cellularimmunity(suppressorTcells,NKcells,cytotoxicTcells)moreimpor

6、tantthanhumoralimmunityincontrollinginfectionInfectiousMononucleosisPathogenesisInfectiousMononucleosisPathogenesisIMWorldDistribution4.MaculopapularEBVRashwithAmoxicillinEyelidedema,Pharyngitis,RashExudativepharyngotonsillitisLymphadenopathyCervicallymphadnopathyHepatosplenomegalyClinicalman

7、ifestationofIMinchildrenandadultsFrequency(%)SignorsymptomAge<4yrAge4–16yrAdults(range)Lymphadenopathy949593–100Fever9210063–100Sorethroator677570–91tonsillopharyngitisExudative455940–74tonsillopharyngitisSplenomegaly825332–51Hepa