异型淋巴细胞IMppt课件.ppt

《异型淋巴细胞IMppt课件.ppt》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

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-limitingdisorderoflymphoidtissuecausedbyinfectionwithEpsteinBa

2、rrvirus(infectiousmononucleosis).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):HerpesFami

3、ly–(linearDNAvirusHHV4),Surroundedbynucleocapsidandglycoproteinenvelope.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

4、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.Lymph

5、ocytesinthetonsilarcryptsaredirectlyinfected->BLOODSTREAM.InfectedBcellsandactivatedTcellsproliferateandexpand.PolyclonalBcellsproduceantibodiestohostandviralproteins.InfectiousMononucleosisPathogenesisMemoryBcells(notepithelialcells)arereservoirforEBV.EBVreceptorisCD21(foundon

6、Bcellsurface)Cellularimmunity(suppressorTcells,NKcells,cytotoxicTcells)moreimportantthanhumoralimmunityincontrollinginfectionInfectiousMononucleosisPathogenesisInfectiousMononucleosisPathogenesisIMWorldDistribution4.MaculopapularEBVRashwithAmoxicillinEyelidedema,Pharyngitis,Ra

7、shExudativepharyngotonsillitisLymphadenopathyCervicallymphadnopathyHepatosplenomegalyClinicalmanifestationofIMinchildrenandadultsFrequency(%)SignorsymptomAge<4yrAge4–16yrAdults(range)Lymphadenopathy949593–100Fever9210063–100Sorethroator677570–91tonsillopharyngitisExudative455940

8、–74tonsillopharyngitisSplenomegaly825332–51Hepa