HSV在线视频

Today we will talk about herpesviruses.
今天我们学习疱疹病毒

I am Gang XIN from Shantou University
我是来自中国

Medical College, China.
汕头大学医学院的辛岗

Hope you’ll enjoy today’s session.
希望你喜欢今天的内容

The name herpes is derived from a Greek
疱疹的名字来源于希腊语

word meaning “to creep”,
意思是“爬行”

referring to the latent,
寓意潜在的

recurring infections typical
反复发作的感染

of this group of viruses.
这也是今天介绍的这组病毒的典型特征

In China,
在中国

we call herpesviruses “paozhen viruses”,
我们称之为“疱疹病毒”

that means viruses
意思是这种病毒

can produce “vesicular lesions”,
会导致“水疱样损伤”

another characteristic of some members
这是疱疹病毒成员的

of herpesviruses.
的另一特征

Look at this mind map,
看看这张思维导图

showing us the viruses we will cover
它向我们展示了这堂课上

in this course.
我们将要学习的病毒

We are done for some of them, right?
我们已经完成了对其中一些病毒的讨论了，对吧？

We have discussed about viruses
我们已经讨论过

Transmitted through respiratory
通过呼吸道和粪口途径

and fecal-oral routes,
传播的病毒

and HIV through blood and secretions,
通过血液和分泌物传播的艾滋病病毒

almost all of them are RNA viruses
除了腺病毒

except adenovirus.
它们几乎全部都是RNA病毒

Today, what we will discuss
今天，我们要讨论的

is an important group
是一群重要的

of DNA enveloped viruses - herpesviruses.
有包膜的，DNA病毒——疱疹病毒

The learning objectives of this chapter:
本章的学习目标是

At the end of this lecture,
学习完本节课后

you should be able to
你应该能够

1.Describe the common characteristics
1.描述人类疱疹病毒的

of human herpesviruses;
共同特征

2.List the clinical diseases caused by
2.列出由以下病原体引起的临床疾病

HSV, VZV, CMV, EBV, HHV-6 and HHV-8;
HSV、VZV、CMV、EBV、HHV-6、HHV-8

3.Give examples of latent infection
3.举例说明潜伏感染

and explain the triggers for the reactivation;
并解释再次激活的刺激因素

4.Explain “TORCH”.
4.解释“TORCH”

In this chapter,
在这一章里

I will tell you three stories.
我会给你们讲三个故事

They are “Professor Li’s cold sores”,
分别是“李教授的感冒疮”

“Mrs. Zhang’s ‘stripe rash’”,
“张阿姨的‘缠腰蛇’”

and story of “bubble boy”.
和“气泡男孩”

For each story,
对每个故事

please think about the questions:
请你思考以下几个问题

What is the disease?
他/她得了什么病？

Why did the person become infected?
为什么这个人会被感染？

And how do we treat the patient
我们应该如何治疗病人

and protect others?
并保护其他人？

The first story
第一个故事

is “Professor Li’s cold sores”.
是“李教授的感冒疮”

Professor Li is 60-year-old.
李教授现年60岁

Sometimes when he is stressed,
有时当他感到有压力

or has a fever,
或者发烧的时候

he will develop some fluid-filled blisters
就会在他的嘴唇上和嘴唇周围

on and around his lips.
出现水疱

He once visited a doctor,
他曾去看医生

and the doctor told him that they were
医生告诉他那些是

cold sores,
感冒疮

also called fever blisters,
也被称为发热性水疱

and was a common viral infection.
是一种常见的病毒感染

He wants to know can this condition
他想知道这种情况

be treated?
能治好吗？

Can he recover
他能够

from the disease completely?
完全康复吗？

Can he transmit this infection to his
他会把这种病毒传染给他

young grandson who is 2 years old?
2岁的孙子吗？

If you were the doctor,
如果你是他的医生

how would you answer these questions?
你会如何回答这些问题？

OK, now let’s talk about this virus,
好了，现在我们来谈谈这个病毒

and you may find the answers along the way.
在接下来的学习中你可能会找到答案

Cold sores are caused by the herpes
感冒疮是由单纯疱疹病毒(HSV)

simplex virus (HSV).
引起的

There are two types of HSV,
单纯疱疹病毒有两种类型

HSV-1 and HSV-2.
HSV-1和HSV-2

Humans are the only natural host.
人类是唯一的自然宿主

Source of infection: patients
传染源:患者

and asymptomatic carriers.
和无症状携带者

It is important to know that both HSV-1
HSV-1和HSV-2的传播

and HSV-2 can be passed
即使没有症状的情况下

on even if no symptoms are present.
也可以传播

HSV is transmitted by direct
单纯疱疹病毒可通过

or indirect contact,
直接接触传播，性接触传播

sexual contact and vertical transmission.
和垂直传播

HSV-1 is usually spread by oral contact
HSV-1通常是通过

through kissing or sharing things such
如接吻，分享牙刷或餐具

as toothbrushes or kitchen utensils.
等方式传播

HSV-2 is spread mainly by sexual contact
HSV-2则主要通过性接触传播

or from an infected mother
或感染的母亲经阴道传播

to her infant during vaginal delivery.
给新生儿

HSV can cause
单纯疱疹病毒会导致

1.lytic infections of most cells
1.大多数细胞的裂解性感染

(mucoepithelial cells),
(如粘膜上皮细胞)

2.persistent infections of lymphocytes
2.淋巴细胞和巨噬细胞

and macrophages,
的持续性感染

3.latent infection of neurons.
3.神经细胞的潜伏感染

Types of infection include primary,
感染类型包括原发性

latent and congenital infections.
潜伏性和先天性感染

1.Primary infection
1.原发感染

HSV-1 and HSV-2 are common human
HSV-1和HSV-2是常见的人类病原体

pathogens that can cause painful
它们可以引起疼痛

but benign manifestations
但表现为良性的

and recurrent disease.
复发性疾病

Primary infection with HSV
HSV的原发感染

can be mild or subclinical,
症状可以很轻或亚临床的

but the initial infection tends
但初始感染倾向于比

to be more severe than recurrences.
复发性感染更严重

80%~90% of the infection are unapparent
80%~90%的感染没有明显症状

or subclinical infections.
或为亚临床感染

The most common symptomatic infection
最常见的有症状的感染

is herpes gingivostomatitis
是疱疹性龈口炎

(infection of the gum and mouth),
(感染牙龈和口腔)

usually caused by HSV-1.
通常是由HSV-1引起的

More than 90% of people in undeveloped
90%以上来自不发达地区

areas have antibodies
的人在2岁时

to HSV-1 by 2 years of age.
体内都有HSV-1的抗体

The other primary infection
另外一种原发感染

is genital herpes,
是生殖器疱疹

with 80% caused by HSV-2.
其中80%由HSV-2引起

This figure shows the diseases
这个图所展示的是由

caused by HSV.
单纯疱疹病毒引起的疾病

HSV-1 and HSV-2 are very similar
HSV-1和HSV-2类似

and can cause the same diseases,
可以引起相同的疾病

except HSV-1 is usually associated
但HSV-1通常与

with infections above the waist,
腰部以上的感染有关

and HSV-2 with infections
HSV-2则与

below the waist.
腰部以下的感染有关

For example,
例如

HSV-1 and HSV-2 both
HSV-1和HSV-2都

can cause encephalitis,
可能导致脑炎

but is usually by HSV-1.
但通常由HSV-1引起的

Both can cause genital herpes,
两者均可引起生殖疱疹

but mostly by HSV-2.
但主要由HSV-2引起

And HSV infection in the neonate
新生儿的单纯疱疹病毒感染

is a severe and often fatal disease
是一种严重，往往致命的疾病

most often due to HSV-2.
最常由HSV-2导致

During the primary infection,
在原发感染期间

viruses replicate
病毒在

in the affected local areas,
受感染的部位局部复制增殖

causing lytic infections
引起粘膜上皮细胞

of mucoepithelial cells,
的溶细胞性感染

that manifest as blisters.
表现为水疱

Then the viruses go to and hide
之后病毒移动并潜伏于

in the nuclei of the sensory neurons,
感觉神经元的细胞核中

establishing latency.
此为潜伏感染

1.Latent infection and recurrence HSV-1
1.潜伏感染和复发

can be latent in the trigeminal ganglion
HSV-1潜伏于三叉神经节

can be latent in the trigeminal ganglion
HSV-1潜伏于三叉神经节

and HSV-2 in sacral ganglion.
HSV-2则潜伏在骶神经节

This diagram shows latent infection
此图显示了HSV-1的

of HSV-1.
潜伏感染

The viruses travel along peripheral
病毒沿着外周

sensory nerves and establish latent
感觉神经传播，并在

infection in the trigeminal ganglion.
三叉神经节中建立潜伏感染

And later under certain circumstances,
之后，在某些情况下

the viruses come out through peripheral
病毒会从外周感觉神经

sensory nerves,
中出来

replicate in the epithelium
并在上皮细胞中复制增殖

to cause vesicular lesions.
引起水疱病变

Recurrent herpes infections
复发性疱疹感染

The symptoms of a recurrent episode
复发感染的症状

are less severe,
相对较轻

more localized, and of shorter duration.
范围更局限，持续时间更短

Infected individuals can develop cold
受感染的个体可患

Sores or fever blisters,
感冒疮或发热水疱

even though they never had a clinically
即使从未出现过

apparent primary infection.
明显的原发感染

The lesions usually occur at the corners
病变通常发生在嘴角

of the mouth or next to the lips.
或唇边

Herpes conjunctivitis and herpetic
疱疹性结膜炎和疱疹性角膜炎

keratitis are also recurrent
也是复发性

infections of HSV.
单纯疱疹感染

Herpetic keratitis
疱疹性角膜炎

can be a severe disease,
可以后果很严重

because the repeated infections
因为反复的感染

can lead to permanent corneal scarring,
会形成角膜上永久性的瘢痕

and blindness.
和失明

Triggers of HSV recurrences may include:
单纯疱疹病毒复发的刺激因素包括

general illness,
一般疾病

from mild illnesses
从轻症变为重症

to serious conditions,such as fever,
比如发热

that is why it
这就是为什么

is also called "fever blister";
单纯疱疹感染也被称为“发热水疱”；

UV radiation, for example skiing, tanning;
紫外线，比如滑雪，日晒

physical or emotional stress, e.g.,
来自身体或心理的压力

final examinations, big date;
例如期末考，重要的任务

menstrual periods;
月经期

spicy or acidic food;
辣的或酸性食物

Immunosuppressed situation,
使用免疫抑制

due to AIDS or after chemotherapy
艾滋病，肿瘤化疗

(for cancer) or long-term high dose
或长期使用高剂量

corticosteroids
皮质类固醇

3. Congenital infection
3. 先天性感染

Neonatal herpes simplex virus (HSV)
新生儿疱疹的感染

infection has high mortality,
病死率高

about 50% in untreated encephalitis.
未经治疗的脑炎死亡率约50%

HSV, mostly HSV-2, is usually
单纯疱疹病毒，大多是HSV-2

transmitted during delivery through
可经易感染的母亲经阴道分娩时传播

the infected maternal genital tract.
给新生儿

Host responses to HSV:
HSV的宿主

As we have mentioned,
如前所述

the rate of anti-HSV-1 antibodies
人群中抗HSV-1抗体阳性率

in most populations is about 70~90%.
约70%~90%

But please note,
但请注意

antibodies cannot prevent recurrence
抗体无法阻止

of the disease.
疾病的复发

Laboratory Diagnosis
实验室诊断

Herpes simplex can be diagnosed
诊断单纯疱疹

with lab tests,
的实验室检查

including detection of the virus
包括检测病毒和

and the antibodies.
对检测病毒抗体

Detection of the Virus:
检测病毒

Tzanck smear is a direct method.
Tzanck涂片是一种直接检测病毒的方法

The clinical samples,
临床样本

such as smear of the vesicular fluid
比如水疱囊液涂片

or biopsy specimen are used
或活检样本都被用来

to identify characteristic CPEs including
确认特征性的细胞病变效应

syncytia (multinucleated cells).
比如多核细胞

Cell culture is the most definitive
细胞培养是最可靠的

diagnostic method for HSV infection.
诊断单纯疱疹病毒感染的方法

Alternatively a definitive diagnosis
或者，通过用ELISA或DFA

can be made by using 酶联免疫吸附测定（ELISA） or DFA
来检测HSV抗原

for detecting HSV antigen
或对病毒DNA进行PCR反应

or PCR for viral DNA.
也可以辅助诊断

Serologic test is useful only
血清学试验只有在

for diagnosing a primary HSV infection,
诊断原发性单纯疱疹病毒感染时才有用

but not useful for recurrent disease,
不用于复发性感染的诊断

because a significant rise in antibody
因为疾病复发时

titers is usually absent in recurrences.
抗体滴度升高并不明显

Prevention and treatment
预防和治疗

Anti-HSV drug, acyclovir (ACV)
抗单纯疱疹病毒药物，阿昔洛韦(ACV)

is the drug of choice.
是首选药物

Treatment prevents or shortens the course
治疗可阻止或缩短原发性

of primary or recurrent disease.
或复发性疾病的病程

But none of the drug treatments
但是没有一种药物

can prevent latent infections.
能预防潜伏感染

No vaccine is currently available for HSV.
目前没有针对单纯疱疹病毒的疫苗

Avoidance of direct contact with
避免直接接触

the vesicular lesions reduces the risk
水疱样损伤可降低

of infection. However,
感染的风险。但是

the symptoms may be subtle,
感染后的症状可能很轻

and thus the virus
因此病毒

can be unknowingly transmitted.
会在不知不觉中传播

Washing with soap can disinfect HSV.
肥皂清洗可以减少HSV感染

Come back to the story.
让我们回到开始的故事

Can you answer Prof. Li’s questions now?
你现在能回答关于李教授的问题了吗？

Please answer the questions by yourself,
请你自己回答这些问题

and have a break.
然后我们休息一下

We will discuss about the answers
下一节我们将公布答案

and continue to discuss
并继续讨论

another herpesvirus, VZV.
另一种疱疹病毒，水痘-带状疱疹病毒(VZV)

Thank you for your attention.
感谢你的聆听

See you next time.
我们下次见