二旋毛虫丝虫

旋毛形线虫Trichinella

spiralis食源性寄生虫病Food-borne

parasitosis人兽共患寄生虫病Parasitic

zoonosis旋毛虫病Causing

trichinelliasis,ortrichinosis旋毛虫属发现8个虫种，我国2个即旋毛型线虫和乡土旋毛虫（后者主要分布北极和亚北）2021/9/131特点characteristics:2021/9/132人畜共患病/食源性寄生虫病zoonosis,

food

borne幼虫致病larvalpathogenesis,后果严重，可引起死亡fatal寄生部位parasitic

position成虫——小肠下端lower

intestinal幼虫囊包——横纹肌striated

muscle150多种动物可自然感染旋毛虫，并成为人类感染的来源2021/9/133Trichinosis

in

the

world2021/9/13466个国家流行，约1100万人感染；罗马尼亚患病率最高的国家，阿根廷在南美是最严重的流行区推测全国约2000万人感染2021/9/135Rudolf

Virchow

(Germany)

suggestedmandatory

diagnosis

of

all

meat

at

theslaughterhouses

in

1877.

This

hasgreatly

reduced

trichinosis

as

humanhealth

problem.One

of

the

first

effective

modern

public

health

measures2021/9/1362021/9/137成虫Adult:幼虫encysted

larva:在横纹肌中in

striated

muscle,如梭形囊包ellipsoidal

sheath,内含1~2条幼虫contain

1~2

curled

larva.形态Morphology3～4mm2021/9/138Life

cycleEncystedlarvaelarvaeadultwormslarvaeIngested

bymammals,

manMigrate

into

mucosa

totodevelopat2

days2021/9/139Migrate

into

lymphatics

and

venules

distributedthroughout

the

body,

in

striated

muscle,

becomeencysted

and6

months

later,

begin

to

calcify,

die.7d囊包（横纹肌）三、生活史成虫（小肠）幼虫血液、淋巴（人/猪/哺乳动物）雌虫寿命1～4月食入幼虫（更换宿主）（脱囊）钻入粘膜幼虫侵入肌肉20天后形成囊包，半年后钙化，少数幼虫可存活

数年幼虫可以侵入其他组织如心、视网膜、脑等，仅仅在骨骼肌细胞后才能存活，该细胞形成nursecell,最后成囊。幼虫在钙化囊内可存活数年~十年。2021/9/13102021/9/1311经口感染,以猪肉为主,ingestion

of

pork生活史必须更换宿主exchange

hosts病人在流行病学上无意义patient

not

infective

source猪-----鼠循环pig---mousecycle特点: Some

characters

of

life

cycle:2021/9/13122021/9/1313致病Pathogenesis侵入期Incubation

or

intestinal

invasion幼虫侵入肠壁导致炎症gastrointestinal

symptoms病程约1周急性幼虫移行期（肌肉期）

Acute,larval

migration肌肉炎症（腓肠肌、肱二头肌、肱三头肌、心肌等）inflammation水肿（脸、眼睑、喉头…）edema炎症反应毒素作用2021/9/13142021/9/1315发热fever,2周-2月（38

º

C-40

º

C）脸面部水肿facial

edema,肌肉酸痛muscle

pain,嗜酸粒细胞升高eosinophilia病程约2－3周幼虫也可移行至肺、心脏、脑部等器官临床特殊症状裂片形出血

splint

hemorrhage亚急性心内膜炎的指甲下线状出血2021/9/13163.

成囊期

Chronic

oncystment

感染后1-2月可持续4-16周急性期炎症消退，肌肉痛持续数月muscle

pain重者：

恶病质、虚脱、毒血症、心肌炎,

死亡cachexia

collapse

toxemia

myocarditis2021/9/1317诊断Diagnosis询问病史History,临床症状clinical

symptoms病原诊断Pathogen—diagnosis:发病后14天肌肉活组织检查muscle

biopsy4.

血清学检测

Serologic

tests: ID,

Circumlarvalprecipitation

test,Bentonite

flocculation

test,

ELISA,IHAOthers:

WBC,

Eosinophil5.

其他2012《国家、卫生行业寄生虫病相关标准汇编》旋毛虫的诊断标准颁布2021/9/1318流行Epidemiology寄生虫动物源性疾病Parasitic

zoonosis,食源性寄生虫病food—borne,生食或半生食猪肉、羊肉Pork

products,囊包抵抗力强

high

resistance,

-15ºC

活

20

天流行地区epidemic：除上海、海南和台湾外均有报道2021/9/1319流行特点epidemic

features：地方性local群体性communal

：“宴请”后食源性food

borne：“肉”烤肉串肉馅…4）季节性seasonal

：冬季多见2021/9/1320美味佳肴：2021/9/1321防治Control1.

加强卫生宣教

hygienic

publicizing：不吃未熟肉

注意火锅水温煮透饺子馅、烤肉串？70ºC可杀死囊包内幼虫2.

加强肉类管理和检疫Inspection

of

pork

and

foodhygiene提倡圈养猪to

rear

livestock

in

pens治疗药物chemotherapy：阿苯达唑甲苯咪唑等22021/9/1322021/9/132342-year-old

woman

who

was

admitted

to

the

Brasov

Hospital

ofInfectious

Diseases

(Romania)

for

fever,

chills,

nausea,

vomiting,fatigue,

myalgia,

and

general

muscle

weakness.

All

thesesymptoms

had

occurred

10

days

before

hospitalization,

at

3

weeksafter

the

ingestion

of

inadequately

cooked

pork

meat.

The

porkmeat

was

confirmed

to

be

infested

with

T.

spiralis.

The

patientwas

a

current

smoker

(10

cigarettes/day),

alcohol

abstinent,

andpre-menopausal,

with

no

relevant

history

of

medical

or

surgicalconditions,

including

cardiovascular

involvement.After

a

routine

ECG(electrocardiogram

)performed

at

theInfectious

Disease

Department,

the

patient

was

transferred

tothe

Cardiology

Department

because

of

abnormal

ECG

recordings.Physical

examination

was

unremarkable.

We

found

regulartachycardia

(110

beats/min),

absence

of

the

third

sound,nocardiac

and/or vascular

murmurs,

blood

pressure

100/60

mm

ofHg,

no

facial

edema,no

signs

of

heart

failure,

and

no

neurologicsigns.Case

study2021/9/1324A

complete

blood

count

showed

mild

leukocytosis

(8.68

x

103cells/µL,

normal

=

4.0–8.0

x

103

cells/µL)

with

left

shift

and

32.9%eosinophils

(absolute

eosinophilia,

2.8

x

103/µL).Bloodbiochemistry

indicated

an

inflammatory

syndromecharacterized

by

a

highly

positive

(++++)

test

for

C

reactiveprotein,

elevated

plasma

fibrinogen

(450

mg/dL),

and

red

bloodcell

(RBC)

sedimentation

rate

of

56

mm

at

1

hour.

Otherabnormalbiochemical

findings

indicated

a

mildliver

cytolyticsyndrome:

alanine

transaminase

(ALT),

54

UI/L;

aspartatetransaminase

(AST),

29

UI/L;

elevated

troponin

I,phosphocreatine

kinase

(MB

fraction

and

total),

and

lactatedehydrogenase

(LDH;

1.06

ng/dL,

3.23ng/dL,

284

UI/L,

and

309UI/L,

respectively).The

clinical

presentation,together

with

the

laboratory

tests,were

highly

indicative

for

human

trichinellosis.1丝虫

Filaria寄生于人体的丝虫有8种，按寄生部位分三类淋巴寄生性:班氏吴策线虫

(班氏丝虫)

Wuchreria

bancrofti马来布鲁线虫(马来丝虫)

Brugia

malayi帝纹布鲁线虫(帝纹丝虫)

B.

timori2021/9/1325淋巴系统2021/9/13262021/9/1327皮肤寄生性旋盘尾线虫(盘尾丝虫)

Onchocerca

volvulus罗阿罗阿线虫(罗阿丝虫)Loa

loa链尾盖头线虫(链尾丝虫)Dipelalonemastreplocerca体腔寄生性常现盖头线虫

(常现丝虫)

D.perstans欧氏曼森线虫

(欧氏丝虫)

Mansonella

ozzardi2021/9/1328Lymphatic

filariasis2021/9/1329我国仅有班氏和马来丝虫，引起的丝虫病（filariasis），是我国五大寄生虫病之一Five

major

parasitic

diseases1994年我国已实现基本消灭丝虫病标准standard（以行政村为单位，人群血液中的微丝蚴率

microfilaremia

降至1%以下）2008年，我国官方向世界庄严宣布：中国

消除淋巴丝虫病国家报告2021/9/1330WHO经过验证：中国是全球唯一的消除丝虫病的国家（2008）丝虫的传播阈值理论人口微丝蚴血症低于1％，无流行病 学意义。2021/9/1331形态Morphology1.

成虫adult2021/9/13322.微丝蚴microfilaria头端钝圆

尾端caudal尖细有体核body

nucleus和头隙(cephalicspace)外披无色透明鞘膜(sheath)染色微丝蚴2021/9/1333在血液中未染色微丝蚴unstained两种微丝蚴的形态鉴别头间隙cephalic

space鞘膜sheath2021/9/1334体核bodynucleus尾核caudalnucleus班氏微丝蚴马来微丝蚴W.

bancroftiB.malayiLengthand244~296

x5.3~7.0177~230

x5~6diameter(um)(um)Appearancegracefulsweepingirregular

kinky

curves,curvesstiff

with

secondary

kinkyCephaliclength

equals

widthlength

twicewidthspaceBodynucleiwelldefined,discreteblurred,

intermingled,,round,

uniform

sizedcrowed

togetherTailnoterminal

nucleitwoterminal

nucleiDistinguishing

both

microfilaria2021/9/1335班氏微丝蚴Bancrofitmicrofilaria马来微丝蚴Malayimicrofilaria2021/9/1336Life

cycleAdult

MicrofilariaeSausageshapedlarvaeFilariformlarvaeLarvaeIngested

by

mosquito,lose

theirsheath

in

1~7

hours

,penetrateand

reach

thoracic

muscle,

2d.2021/9/1337Migrate

through

out

the

hemocoel

eventuallyreachingthe

labium

enter

the

skin

throughthe

wound

by

mosquito

feeding

on

bloodPass

throughperipheral

lymphatics3

months

needed三.生活史丝状蚴（蚊下唇）叮咬人体童虫进入大淋巴管、淋巴结需两个宿主：人体内：成虫——终宿主蚊体内：幼虫——中间宿主成虫 微丝蚴

蚊吸血

腊肠状蚴（淋巴系统）

（血液）

（蚊胸肌）2021/9/13381.

蚊体内发育in

mosquito

stage：只有发育development，没有繁殖reproduction适宜温度optical

temperature：20~30ºC相对湿度humidity：75~90%发育时间

developmental：班氏——10~14天马来——

6~ 6.5天2021/9/1339蚊的感染度infectiosity：血液中微丝蚴密度

density大于15条/20mm³大于100条/20mm³蚊感染成功蚊易死亡2021/9/1340丝虫感染性幼虫丝状蚴自蚊下唇labiumof

mosquito逸出2021/9/13412021/9/13422.

人体内发育in

human

stage（1）寄生部位：lymphatic

system马来——浅部淋巴系统superficial：上、下肢班氏——浅部淋巴系统+深部deep如下肢、 精索、 阴囊、

肾盂、腹股沟lower

limbs

varicosity

scrotum

pyel

groin异位寄生ectopic：眼前房、乳房、肺等2021/9/1343（2）夜现周期性

nocturnal

periodicity微丝蚴在周期性在外周血液peripheralblood中出现的规律昼少夜多的现象夜间入外周血液白天停留在肺部毛细血内

pulmonary

capillary班氏微丝蚴——晚10：00~2：00（凌晨）马来微丝蚴——晚

8：00~

4：00

（凌晨）2021/9/1344（3）成虫寿命longevity：4～10年（4）微丝蚴：2-3个月（2年）保虫宿主reservoir

host：班氏：罕见马来：多种哺乳类动物mammals动物模型animal

model长爪沙鼠Gerbil——马来丝虫2021/9/13452021/9/1346致病

Pathogenesis1、带虫者——微丝蚴血症者（Microfilaremia）2、急性期过敏和炎症反应The

acute

allergic-inflammatory

phase淋巴结炎淋巴管炎离心性淋巴管炎（流火）多见下肢淋巴管丹毒样皮炎

多见小腿内侧及内踝部丝虫热

filarial

fever

发热:

38-39

ºC深部的淋巴管、淋巴结炎2021/9/1347淋巴结炎和淋巴管炎常同时发作，常见于腹股沟和股部睾丸炎funiculitis

、附睾炎epididymitis、精索炎orchitis,机理：全身性过敏反应allergy

+局部炎症反应inflammation3、慢性期阻塞性病变The

chronic

obstructive

phase睾丸鞘膜积液(hydrocele

testis)乳糜尿（chyluria）乳糜腹水

ascites乳糜腹泻

diarrhea象皮肿（elephantiasis）2021/9/1348班氏丝虫导致：睾丸鞘膜积液hydrocele

testis积液中可查见到

microfilaria2021/9/1349乳糜尿chyluria2021/9/1350马来丝虫和班氏丝虫均可导致：象皮肿elephantiasis以下肢、阴囊多见2021/9/13512021/9/13522021/9/13532021/9/13542021/9/13552021/9/13562021/9/13574、隐性丝虫病Suppressed(occult)filariasis（热带肺嗜酸性粒细胞增多症tropical

pulmonaryeosinophilia,TPE）机制：由一型变态反应所致

Type

I

hypersensitivity

reaction2021/9/1358诊断1、病原诊断Examination

of

pathogen厚血膜法Thick

bloodfilm,新鲜血滴法Fresh

blood

drop,浓集法Concentratedlysed

blood海群生诱检法Luring

method.各种体液检查Body

fluid

and

urinetest:组织活检

Biopsy:

病理切片(查成虫)sectionWS

260-2006

丝虫病诊断标准(卫生行业标准）2021/9/13592、免疫诊断

Immunologic

diagnosis检测抗体Circulating

antibody检测抗原Circulating

antigen3、其他方法分子技术Molecular

technique探针DNA

probe,PCR and

PCR-ELISA

etc流行情况1.

分布世界：亚洲、非洲WHO：2020年全球消灭淋巴丝虫病globalelimination我国94年宣布基本消灭丝虫病great

achievement2006

公布丝虫病消除标准、诊断标准2008年官方宣布消灭丝虫病2021/9/13602.

流行因素传染源infective

source（微丝蚴密度>5条/60µl)病人 慢性病人

acuteandchronic？带虫者

carrier传播媒介

vector

世界各地报道蚊媒30多种淡色库蚊、致倦库蚊culex——班氏丝虫嗜人按蚊、中华按蚊anopheles——马来丝虫我国东南沿海地区媒介为东乡伊蚊。（3）易感人群susceptible

population自然因素natural

factor社会因素social

factor感染季节5～10月我国2021/9/13612021/9/1362防治Prevention

and

Treatment1、普查普治popularization

1岁以上居民接受血检（95％受检率），阳性者治疗治疗病人treatment：首选药物：海群生(hetrazan)（乙胺嗪）其他药物：呋喃嘧酮伊维菌素FurapyrimidoneIvermectin(IVM)2021/9/1363预防措施prevention：药盐疗法

0.3%

medical

salt

of

hetrazan

：0.3%海群生掺拌食盐（流行区）对慢性病人：象皮肿病人——烘绑疗法Pressing

bandaging阴囊象皮肿、鞘膜积液者——手术Surgical

removal中医疗法Chinese

medicine

use2、防蚊灭蚊Mosquito

control64监测工作Epidemiological

survey人群监测 普查 血检受检人数需达到流行population

survey

区总人口3%以上和流行乡镇的30%以上原微丝蚴血症人群监测（1次/年）流动人口血检监测蚊媒监测mosquito

survey血清学监测捕捉当地媒介蚊种，解剖蚊子检查有无丝虫幼虫ELISASerologic

survey巩固防治成果2021/9/132021/9/1365Simultaneous

filarial

infection

of

thepleura

and

breast----- case

reportA

30-year-old

woman

presented

with

a

swelling

in

theleft

breast

of

4

months'

duration,

and

left-sided

chestpain,

occasional

dry

cough

and

breathlessness

onexertion

for

the

past

3

weeks.The

breast

lump

was

3

x

2

cm

in

size,

located

in

theupper

inner

quadrant

of

the

left

breast.

It

was

slightlytender

to

the

touch,

firm

in

consistency

and

fixed,

andthe

overlying

skin

was

normal.

Physical

examinationofthe

chest

suggested

a

left-sided

pleural

effusion.2021/9/1366Peripheral

blood

examination

showed

eosinophilia(eosinophils

18%,

and

absolute

eosinophil

count

1296/[micro]l).

Pleural

aspirate

showed

an

exudativepattern,

and

cytological

examination

revealed

apredominance

of

lymphocytes,

few

eosinophils,mesothelial

cells

and

microfilariae.

Themicrofilariae

were

sheathed

and

their

terminalends

(tips)

were

devoid

of

nuclei,

characteristic

ofW.

bancrofti.

Needle

aspiration

of

the

breast

lumpshowed

a

chronic

inflammatory

infiltrate,

with

afew

interspersed

eosinophils,

occasionalgranuloma

formation

and

parts

of

gravid

adultworm.

A

few

microfilariae

of

W.

bancrofti

were

alsoseen.

A

thick

peripheral

blood

smear

examination(nocturnal)

showed

numerous

live

microfilariae.盘尾丝虫病Onchocerca

volvulusCoursing

onchocerciasis流行于非洲、中南美洲、西亚34个国家，受威胁

9千万人，受感染1760万人，致盲32.6万人。本病可导致严重眼部损害或失明称河盲症（riverblindness)2021/9/1367本病经媒介昆虫——蚋Simulium

传播2021/9/1368微丝蚴导致角膜损伤，形成角膜瘢痕幼虫（微丝蚴）——结节附近结缔组织、皮肤淋巴管内、眼、尿内等主要导致眼部损害 称河盲症(river

blindness)2021/9/1369Africa

River

blindness(5~20%)2021/9/13702021/9/1371非洲的河盲症患者riverblindness

in

AfricaMicrofilariae

in

skin-

in

parts

of

Africa,

the

skin

of

the

scrotum

and

inguinalarea

loses

its

elasticityHanging

groin2021/9/1372微丝蚴导致皮肤失去弹性，皱缩、垂挂。Diagnosis

of

Onchocerca

volvulusExamination

of

microfilariae

or

adult

in

skin

nodule,

eye

etc.Skin

biopsy2021/9/13732021/9/1374Diagnosis皮肤、眼部、尿液、痰液和淋巴结查微丝蚴Chemotherapy:海群生、苏拉明、伊维菌素等罗阿丝虫病Loa

loaCausing

loiasis流行于西非、中非热带雨林，病人约200～300万。丝虫成虫——皮下及深部结缔组织本病经媒介昆虫——斑虻(chrysops)传播2021/9/1375斑虻chrysops2021/9/1376成虫可侵入各脏器，眼多见（非洲眼虫病）卡拉巴丝虫性肿块Calabar

swelling（游走性fugitive），刺痛、搔痒、灼热，蚁走感，游走性肿胀2021/9/1377Calabar

swelling2021/9/13782021/9/1379微丝蚴——血液，可引致脑膜脑炎微丝蚴为昼现周期性治疗treatment：外科手术surgical

remove药物chemotherapy大剂量海群生 伊维菌素2021/9/13802021/9/1381Learning

guides:After

studying

this

chapter

the

student

should

be

able

todescribe

the

major

characteristics

of

life

cycle

of

both

parasitesIllustrate

the

mechanism

of

pathogenesis

of

both

parasites.explain

the

nocturnal

periodicity

of

microfilaria.demonstrate

the

major

clinic

symptoms

of

T.spiralis,

and

chronicobstructive

disease.List

the

major

choice

of

laboratory

diagnosis