【医学ppt课件】旋毛虫

Reviewofintestinalhelminths Ascarislumbricoides roundworm 似蚓蛔线虫 蛔虫 Trichuristrichiura whipworm 毛首鞭形线虫 鞭虫 Enterobiusvermicularis pinworm 蠕形住肠线虫 蛲虫 AncylostomaduodenaleNecatoramericanus hookworms 钩虫 Trichinellaspiralis旋毛形线虫 Tissue blooddwellingnematodes Filaria丝虫 Wuchereriabancrofti班氏吴策线虫Onchocercavolvulus旋盘尾丝虫 ThehistoryofTrichinellaspiralis Inyear1835 YoungJimPaget afirstyearmedicalstudentatLondonHospitalMedicalSchool rushedintotheautopsyroom The51yr oldItalianbricklayerwhohaddiedoftuberculosis andthattheywerenowdissecting alsohad sandydiaphragm aconditionthatdulledeventhesharpestofscalpels Well anyway whentheyhadallclearedtheroom Jimquietlystolebackinandremovedasmallbitofmuscletissuefromthediaphragm Hewasmorethancuriousastothenatureof sandydiaphragm Hefirstexamineditwithhistrustyhandlenshecarriedforjustsuchasituation Hethoughthesawsmallwormscoiledupinsideeachnodule Uponevenhighermagnification thepresenceofcoiledwormswasrevealed Fromwww trichinella org Trichinellaspiralis JimPagetWormsinthe sandydiaphragm Trichinellaspiralis Trichinawormswereobservedinporkin1846byJosephLeidy Hesavedhundredsoflivesbyrecommendingcookingporkatahighenoughtemperaturetokilltheorganism Lifecycleworkoutin1850 sByRudolphVirchow Trichinellacontrol RudolfVirchow Germany suggestedmandatorydiagnosisofallmeatattheslaughterhousesin1877 ThishasgreatlyreducedtrichinellosisashumanhealthProblem WorldwideDistributionParasiticzoonosisFoodborneparasitosis Trichinellaspiralis cause旋毛虫病trichinosis trichiniasis ortrichinelliasis DistributionofTrichinellaspiralis Trichinosisismostcommonintemperateandarcticclimates highprevalenceinpork eatingareasoftheworld arctic temperate AdultsofTrichinellaspiralis Adults small 1 5 4mmLarva femalesgivebirthtolarva Eggs hatchinuterus子宫 stichosome HatchedLarva 杆状体 成虫形态在诊断上无意义 特点 直接产幼虫 Encystedlarva幼虫囊包 infectivestage 0 25 0 5mm 0 21 0 42mmLemonshape1 2larvainthecyst Lifecycle AdultfemaleinmucosaofsmallintestineTrichinacystsinskeletalmuscle骨骼肌 Pathogenisis 3stages 1 Invasion 1week firstsymptomsappear12hoursto2daysfollowingingestionoftrichinacysts Nausea vomiting diarrhea abdominalpain headachewithslightfever 2 migrationoflarvae 2weekto2months penetrationandencystmentinskeletalmuscles骨骼肌 migrationoflarvae 2weekto2months Eosinophilia嗜酸性细胞增多Deathsarerareandduetomyocarditis心肌炎 encephalitis脑炎andpneumonia肺炎 Weakness Headacheanddizziness头昏 Fever chillsandsweating Myalgia肌痛 perorbitaledema splinterhemorrhages underfingernails 3 calcification ifonesurvivesstage2 occursseveralmonthsafterinfection calciumisdepositedaroundthecysts Larvaeventuallydieinayearorlonger Inhumaninfections 5larvae grambodyweightarefatal Musclebiopsy trichinacystscanbeseenwithmicroscope Musclesamplesweresqueezedbetweentwoglassplates 2 ELISAtoidentifyTrichinellaantibodies Diagnosis 肌肉压片 Others Epidemiology 1 Cosmopolitandistribution2 Sourceofinfectionisporkorporkproductsinfectionismostfrequentsamongethnicgroupsdisposedtoeatraworpoorlycookedporkproducts TreatmentofTrichinellaspiralis Drugs Mebendazole 甲苯哒唑 Albendazole 阿苯哒唑 丙硫咪唑 Others PreventionofTrichinellaspiralis Thoroughcooking temperatureabove58oC microwavecookingofporkroastsandchops withbone isNOTeffectiveinkillingtrichina2 freezingfor20dayswillkilltemperateclimatestrain freezingisNOTeffectiveagainstthearcticstrain smoking salting anddryingpork bearorothermeatwillNOTkilltrichinalarvae PreventionofTrichinellaspiralis 3 Donotfeedporkscrapsingarbagetopigs eliminateratsinareaswherepigsarekept Tissue blooddwellingnemotodes Filaria causefilariasis Fourimportantfilarialwormsparasiticinhumansare Wuchereriabancrofti班氏吴策线虫Onchocercavolvulus旋盘尾丝虫Brugiamalayi马来布鲁线虫Loaloa罗阿罗阿线虫 W bancroftiisstrictlyahumanpathogenandisdistributedintropicalareasworldwideMorethan80millionwereaffected Orient SouthPacific andSouthernAsiatoIndia overlapswithWuchereriabancrofti butdoesnotoccurinAfricaorSouthAmerica B malayiinfectsanumberofwildanddomesticanimals Morphology AdultsofWuchereriabancrofti Adultsoccurinthelymphaticvessels AdultB malayiareonlyhalfthesizeofW bancrofti filariformlarva丝状蚴 MicrofilariaeofWuchereriabancrofti MicrofilariaeareseeninbloodsmearsandareDIAGNOSTICwormsare230 320 mlong MorphologicaldifferencesofmicrofilariaeofWuchereriabancroftiandBrugiamalayi WuchereriabancroftiBrugiamalayiLength244 296 5 3 5 7177 230 5 6 m AppearancegracefulsweepingIrregularkinky体态curvescurvesCephalicspacelengthequalswidthlengthtwicewidth头隙Bodynucleiwelldefined discrete blurred intermingled体核round uniformsizednucleicrowdedtogetherTailnoterminalnucleitwoterminalnuclei尾核 Filariformlarve infectivestage MicrofilariaeofWuchereriabancrofti Nocturnalperiodicityofmicrofilariae夜现周期性 PathologyofWuchereriabancrofti Incubationperiodnosymptoms3clinicalphases microfilaremia nosymptomsormildsymptoms 微丝蚴血症 Acuteallergicinflammatoryphasea lymphadenitis lymphangitis淋巴结炎淋巴管炎 Acuteallergicinflammatoryphaseb filarialfever丝虫热c funiculitis orchitis epididymitis精索炎 睾丸炎 附睾炎 3 chronicObstructivephase Elephantiasis象皮肿 Thedisfiguredlegsoflymphaticfilariasispatientswaitingformedicalattention b chyluria乳糜尿 hydroceletestis鞘膜积液 Brugiamalayi马来丝虫 Adultsliveinlymphaticvesselsandcauseelephantiasisinarmandleg DifferencebetweenW randB m discusslater Diagnosis IdentifyingmicrofilariainbloodorotherfluiddirectbloodfilmsconcentrationsofbloodspecimensandurinespecimensIdentifyingadultsSerologictesting Epidemilogy WorldWidedistributionSourceofinfection patientsandinfectedpatientsTransmission bymosquittoBrugiamalayiWuchereriabancrofti TreatmentofWuchereriabancrofti Drugs hetrazan海群生aresomewhateffectivekillmicrofilariaeandadultswithcarefuladministration 6mg kgdiethylcarbamazinecitrate DEC 400mgalbendazole 150 g kgivermectin 400mgalbendazole inthecaseofco endemicitywithonchocerciasis AthirdoptionistofollowatreatmentregimenusingDEC fortifiedcookingsaltdailyforaperiodof12months GlobalProgrammetoEliminateLymphaticFilariasis others Pressurebandagesonenlargedlimbsforceslymphout 弹力绷带捆绑Surgerycanbeusedtoremoveelephantoidtissueifmuscleinvolvementisminimal 外科手术 Onchocercavolvulus旋盘尾丝虫 Causativeagentofonchocerciasis riverblindness 90million 17 6million 326thousand AdultsofOnchocercavolvulus Skinnodule Microscopicsectionshowingadultsandscartissuereaction MicrofilariaeofOnchocercavolvulus Unsheathedmicrofilariaeoccurintheskin neverthebloodsteam Simulium蚋 Pathogenisisofadults Nodules about 1inchindiameter aremostcommoninAfricaNodulesinCentral SouthAmerica Nodulesarerelativelybenign Microfilariaeintheskin itchingissoseveresomepeoplehavecommittedsuicide PathogenisisofMicrofilariae Microfilariaeinskin inpartsofAfrica theskinofthescrotum阴囊andinguinalarea腹股沟losesitselasticity 2 Microfilariaeinvadetheeye occurasmicrofilariaedieintheeye Microfilariaeinvadetheeye InmanypartsofAfrica thesightedyoungareresponsibleforleadingtheolderblindadults DiagnosisofOnchocercavolvulus Examinationofmicrofilariaeoradultinskinnodule eyeetc TREATMENTofOnchocercavolvulus DrugsIvermectin 150mg kg Every6 12