肺吸虫病ppt中国医科大学课件

并殖吸虫病（肺吸虫病） paragonimiasis 中国医科大学附属第二医院感染科 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 概述 n寄生于人体内脏器（肺部为主）或皮下组织的 并殖吸虫所致的一种慢性寄生虫病 n人吞食含有并殖吸虫活囊蚴的溪蟹或喇蛄而感 染 n临床表现：卫氏并殖吸虫引起以肺部病变为主 的全身性疾病，主要表现为咳嗽、咳铁锈色或 烂桃样痰、咯血等，称肺吸虫病。斯氏狸殖吸 虫引起的主要病变是游走性皮下包块和渗出性 胸膜炎 n自然疫源性疾病 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病原学 n病原体：卫氏并殖吸虫和斯氏并殖吸虫 卫氏并殖吸虫：三倍体型虫体能在体内 成熟并产卵，二倍体型不适宜于人体寄 生 斯氏并殖吸虫：虫体狭长，在人体不能 发育为成虫。终宿主为犬、猫、果子狸 等 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病原学 n生活史： n虫卵随粪便或痰入水 n25-30C，21天孵出毛蚴 n第一中间宿主：淡水螺。无性生殖发育，3个月左 右，尾蚴逸出。20 C水中存活1-2天 n第二中间宿主：甲壳动物（溪蟹、喇蛄），形成 囊蚴，囊蚴是并殖吸虫的感染型 n人吞食含有并殖吸虫活囊蚴的溪蟹或喇蛄而感染 n幼虫在小肠内逸出，侵入组织，在体内游走，虫 体窜行游走和贯穿组织能力强，主要寄生于肺组 织（卫氏） n囊蚴感染制成虫发育成熟需2-3个月。寿命6-20年 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 流行病学 n传染源：病人是卫氏病殖吸虫的重要传染源。 通过痰或粪便排出虫卵。某些家畜和野兽是并 殖吸虫的保虫宿主和传染源。病人不是斯氏并 殖吸虫的主要传染源。犬、猫、果子狸等为其 保虫宿主和传染源 n传播途径：生食或半生食含有囊蚴的溪蟹、喇 蛄或进食含有童虫的野猪肉或生饮溪水而感染 n易感人群：普遍易感。 n流行特征：分布广泛。东北地区为喇蛄型卫氏 并殖吸虫流行区 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 发病机理 n童虫引起的病变：后尾蚴和童虫在肠道和腹腔 及胸腔内窜行游走引起窦道和炎症渗出。斯氏 并殖吸虫可引起寄生部位嗜酸性肉芽肿，形成 游走性皮下包块，渗出性胸膜炎和肝损害较重 n成虫引起的病变：可固定于某一部位，也可游 走窜行。形成多房性脓肿、囊肿、结节与瘢痕 n虫卵引起的病变：组织反应轻微 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 病理解剖 n基本病理改变： n脓肿期：单核细胞、嗜酸性粒细胞和中性 粒细胞浸润 n囊肿期：肉芽组织形成，围以纤维囊壁， 囊内有棕褐色囊液 n纤维瘢痕期：肉芽组织和纤维组织增生 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 临床表现 n潜伏期3-6个月。临床表现复杂，起病缓慢 n急性并殖吸虫病； n慢性并殖吸虫病： n卫氏并殖吸虫和斯氏并殖吸虫的临床表现不同见 表全身症状：发热（低热）、头痛、胸闷，过敏 症状（荨麻疹、哮喘）。斯氏并殖吸虫多见 n临床分型： n胸肺型：咳嗽、咳痰、咯血、胸痛、气短。铁锈色或棕 褐色烂桃样血痰为最典型症状。（为肺部坏死组织，痰 中可查到虫卵）有单侧或双侧胸腔积液。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 卫氏并殖吸虫病与斯氏并殖吸虫病的鉴别表 卫氏并殖吸虫病 斯氏并殖吸虫病 全身症状 不常见 常见 荨麻疹 不常见 很常见 咳嗽 明显，伴中等或大量痰液 轻咳，痰量很少 咳痰 铁锈色痰，棕褐色痰或烂桃肉样 血丝痰 胸膜炎、胸腔积液 较少见 常见 肺部损害 常见 少见 肝损害 较少见 较常见 皮下结节与包块 10-20%病人可见，结节内查见 30-70%病人可见，有游走 虫卵或成虫 性包块，包块内偶见幼虫 ， 未见成虫或虫卵 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 临床表现 n腹型：腹痛（阵发性或下腹隐痛）、腹泻、恶 心、呕吐、肝肿大和肝功能异常。脓肿破溃可 排棕褐色粘稠血便。斯氏并殖吸虫可引起肝功 能异常 n脑脊髓型：2-5%，卫氏并殖吸虫多见 n脑型：儿童和青壮年严重感染者。 n颅内压增高症状：多见于早期 n脑组织破坏症状：后期出现 n刺激性症状：癫痫发作 n炎症性症状：多见于早期 n脊髓型：运动障碍、感觉缺失、坐骨神经痛、大 小便失禁 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 临床表现 n皮肤型：皮下结节或包块 n阴囊肿块型： n亚临床型：疫区多见隐性感染 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 实验室检查 n一般检查: n血像：白细胞总数增高，急性期嗜酸粒细胞可达 80%以上。 n脑脊液、胸腹水：嗜酸粒细胞增高 n血沉：增快 n病原检查： n痰查虫卵，粪便查虫卵 n体液：查虫卵，嗜酸细胞增多，夏科雷登结晶 n皮下结节和包块活检 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 实验室检查 n免疫学检查： n皮内试验：1：2000成虫抗原接种前臂皮内。筛查 n酶联免疫吸附试验：与病人虫卵阳性符合率达 100%。滴度 1：800可以确诊。考核疗效 n快速斑点酶联免疫吸附试验或单克隆抗体蛋白印 记（western blot)：早期诊断 n后尾蚴膜反应、间接血凝试验、间接荧光抗体试 验、RIA、ABC-ELISA等 nX线检查：早期。肺部炎性浸润，囊肿及胸腔 积液。CT Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 诊断 n流行病学资料： n临床资料： n实验室检查：痰、粪便或体液中查到虫卵，皮 下结节活检发现虫卵、童虫、或成虫可以确诊 。免疫学检查有诊断意义 鉴别诊断 n肺结核、肺癌 n脑部寄生虫病和脑肿瘤 n病毒性肝炎、肝脓肿 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pt