plasmodia病理生理学英文课件.ppt

Prof.HuanhuanShi,MalariaParasite,病历摘要,男，35岁，高热伴寒战、大汗7天，意识不清2天入院，体检发现贫血、脾肿大，2日后抢救无效死亡患者半年前曾去非洲尼日利亚，尸检发现血液内大量疟原虫,为何该病人有寒战伴高热、大汗？为何该病人出现意识不清并最终死亡？为何该病人有贫血并伴随脾肿大？,寄生于人体的疟原虫,间日疟原虫PlasmodiumvivaxP.v.,恶性疟原虫P.falciparumP.f.,三日疟原虫P.malariaeP.m.,卵形疟原虫P.ovaleP.o.,世界性分布(国内、广西常见）,主要分布于国外,Vivaxmalaria,Quartan,Ovalemalaria,falciparummalaria,Malariaisoneofthemajorpublichealthchallengeserodingdevelopmentinthepoorestcountriesintheworld.,Whyworryaboutmalaria?,Malariamakesthepoorevenpoorer,MalariacostsAfricamorethanUS$12billionannually.IthasslowedeconomicgrowthinAfricancountriesby1.3%peryear,Morphology,Anopheles,Humanbody,Morphology,InbloodsmearsstainedbyGiemsas,Plasmodiacytoplasmwerestainedaslightbluecolorandnuclearchromatinredcolor,whilecytoplasmoftheinfectederythrocytestainspinkcolor.,RBC（pink）,Nuclear（redorpurple）,Cytoplasm（lightblue）,Pigment,Schuffnersdots,ErythrocyticstagesofP.v,Ringform,Largetrophozoite,immatureschizont,matureschizont,microgametocyte,macrogametocyte,Erythrocyticcycle,merozoite,Erythrocyticstage,Ringform环状体,Amoeboid,Trophozoite大滋养体,Erythrocyticstage,ImmatureSchizont未成熟裂殖体,matureschizont成熟裂殖体,Erythrocyticstage,Formationofgametocyte,Microgametocyte雄配子体,Macrogametocyte雌配子体,Formationofgametocyte,Ringform,ErythrocyticstagesofP.f,macrogametocyte,microgametocyte,LargetrophozoiteandschizontofP.f.areseldomseeninperipheralblood.,Ringform,gametocyte,ComparisonbetweenP.vandP.f,Ringform,Largetrophozoit,schizont,gametocyte,P.v,P.f,Seldomseeninperipheralblood,Lifecycle,Anopheles,Humanbody,子孢子,速发型,迟发型,红外期8d,6-12M,裂殖体,裂殖子,环状体,大滋养体,裂殖体,裂殖子,巨噬细胞吞噬,侵入红细胞,雌配子体,雄配子体,人体内,按蚊体内,雄配子,雌配子,合子,动合子,囊合子,子孢子,红内期（48h）,配子生殖期,孢子增殖期,肝细胞内,红细胞内,P.m.72hP.f.48h,P.o48h,间日疟原虫生活史,1、无迟发型子孢子，故无复发；,2、红外期发育时间：6天；,3、大滋养体和裂殖体在内脏与皮下脂肪毛细血管内寄生，在外周血中不易查见。4、外周血现疟7-10天才出现配子体。,P.f.与P.v.的生活史比较，主要不同点,生活史学习要点：1.感染阶段：子孢子；红内期疟原虫2.感染途径与方式：蚊虫叮咬;输血或经胎盘。3.致病阶段：红内期疟原虫4.寄生部位：肝细胞、红细胞5.媒介：雌性按蚊(为终宿主）6.诊断阶段：红内期原虫,Pathogensis&manifestation,子孢子侵入,初发,再燃,复发,潜伏期,隐匿期,隐匿期,6-12个月（P.V迟发型）,速发型,TheProcessofmalarialinfection,Include:incubationperiod,firstparoxysm,recrudescenceandrelaps.,Incubationperiod潜伏期,Theincubationperiodrepresentstheintervalbetweenthebiteofinfectingmosquitoandonsetofclinicalsymptoms.Itisthedurationofpreerythrocyticperiodandthetimeoferythrocyticparasitiesmultiplyingsufficientlytotheliminalvaluethatisabletoproduceclinicalsymptoms.,Incubation:P.v.-transmittedbymosquito:around14d.transmittedbybloodtransfussion:around7dlongincubation:6m-12m.P.f.-transmittedbymosquito:around11d.,Malarialparoxysm,Feverwithtertianperiodicityinvivaxmalaria,Bloodstageparasitesareresponsiblefortheclinicalmanifestationsofthedisease.,Symptomsofmalariatypicallyconsistofdefiniteparoxysmsofchills,feverandsweating.,疟疾发作,Highersympatheticexcitability,Merozoites,metabolitesofmalariaparasite,denaturedhemoglobinandfragmentinfectedRBC,stimulate,Nervecenterthatcontrolstemperature,Mechanismofparoxysm,Fever,Exogenousorendogenouspyrogen,Typicalmanifestation,Chill寒战,Highfever高热,Sweating出汗退热,30-60min,3-4h,2-3h,Feverwithtertianperiodicityinvivaxmalaria隔天发作，呈周期性,寒战高热,出汗退热,间日疟隔一日发作一次,三日疟隔两日发作一次,裂体增殖周期,疟疾发作周期,=,AvictimofHighlandMalariaatTransMaraMedicalCenter,AyounggirlwithHighlandMalariawaitingformedicineatShankoe,Malariapatients,Recrudescence再燃,Recrudescenceistherecurrenceofsymptomsafteratemporaryabatement(somedaysorweeks).P.falciparumistheusualcauseofrecrudescentinfectionsandthesearise2-4weeksfollowingtreatment.ReasonmalariaparasitesremainedinRBCmultiplyagain.,Relapseisthereturnofadiseaseafteritsapparentcessation.BothP.vivaxandP.ovalehaveatendencytorelapseafterresolutionoftheprimaryinfection.Relapsesoccurweeksormonthsaftertheprimaryinfection.Reasonbradysporozoitesstayedinhepaticcellmultiply.,Relapse复发,Cerebralmalaria(CM)脑型疟-SevereFalciparumMalariaCM,life-threateningmalariaisnearlyalwayscausedbyP.falciparum.Thesymptomsareveryserious,suchasLastinghightemperature(40-41C),unconsciousnessandshock.HighmortalityOverallmortalityintreatedcerebralmalariainreportedstudiesaverages15%inchildrenand20%inadults(butupto50%inpregnancy),Myheadhurtssomuch,1.AnemiaREASON*Destructionoferythrocytesparasitized*Enhancementofspleenfunction*Depressionofmarrowfunction*Immunopathologicalmechanisms,complications,2.Hepatosplenomegalia,Enlargedliverandspleen(belownavel),Hyperplasiaofreticuloendothelialsystem,Reason:,3.Malarianephritis疟疾肾病多见于P.m感染的慢性病人4.Feverwithdarkurine黑尿热常见于G6PD缺乏者服用伯喹等药物引起,Laboratorydiagnosis,Thinorthickbloodfilm1.Collectionofblood:peripheralbloodsmears2.GiemsaorWrightsstaining3.Examinationundermicroscopy,Laboratorydiagnosis,Takingfinger(orearlobe)prickbloodformalariatest,Adoctortakesabloodsmearfromababy,Laboratorydiagnosis,Ahospitalworkerexaminingabloodsmear,Immunodiagnosis1)Detectionofanantigen2)DetectionofantibodiesMoleculardiagnosisPolymerase-chainrection(PCR),Laboratorydiagnosis,MolecularDiagnosis,LaneS:molecularbasepairstandard(50-bpladder).Blackarrowsshowthesizeofstandardbands.Lane1:P.vivax(size:120bp)Lane2:theredarrowshowstheP.malariae(size:144bp)Lane3:P.falciparum(size:205bp)Lane4:P.ovale(size:800bp),Laboratorydiagnosis,Epidemiology&control,DistributionMalariaisprobablythemostwidespreadofalldiseases.P.vivaxiswidespreadinthetropicsandsub-tropics,andinsometemperateregions.P.falciparumisfoundmostcommonlyinwarmmoistclimates.P.malariaeoccursthroughoutthetropics.P.ovaleisuncommon.,Epidemiology,GeographicDistribution,根据世界卫生组织发布数据，全球86的疟疾病例发生在非洲，9的病例发生在东南亚，其余5的病例分布在全球其它地区。,（2）国内疟疾流行区（2013）,2013年全国报道3000例，流行区范围大幅度缩小，除云南、海南两省外，其他省份已消除恶性疟。但是，近年来，由于外出务工、经商、旅游等人口流动频繁，输入性疟疾病例呈上升趋势。比较典型案例的是2013年广西上林县加纳务工返乡人员事件。2012年发现127例，而2013年6月,由于大批在非洲加纳务工人大集中返乡,上林县输入性疟疾病例出现大幅上升。上林县卫生部门共对2079名疫区返乡人员进行了血检,报告病例389例,所有疟疾病例均为输入性病例。我国疟疾主要流行于云南、海南、贵州等南部地区和安徽、河南、江苏、湖北等中部地区。,Sourceofinfection.,Thepatientsorcarrierswhosebloodcontainsmaturegametocytes.,Mosquitovectors,Anophelinemosquitoesarethevectorsofmalaria,InChina:A.sinensis中华按蚊minimus微小按蚊A.anthropophage嗜人按蚊A.dirus大劣按蚊,Epidemiology,Susceptiblepersons,Epidemiologicfactors,Theepidemiologyofmalariaisinfluencedbytheclimate,topography,socio-economicstatuso