并殖吸虫病Paragonimia课件

1、并殖吸虫病Paragonimia1 并殖吸虫病Paragonimia2 Intruduction w A kind of chronic disease caused by paragonimus westermani, paragonimus szechuanensis and several other related species w Adult worm of paragonimus westermani inhabit lungs of the final host, causing cough, chest pain, rusty sputum and hemoptysis w

2、paragonimus szechuanensis cause subcutaneous nodules and masses w Infected by eating raw crayfish and freshwater crab 并殖吸虫病Paragonimia3 并殖吸虫病Paragonimia4 Morphology w Adult worm: they are monoecious, the reproductive organs are parallel, have two suckers w Eggs: golden brown, ovate, operculate, the

3、size is 80-12048-60m w Metacercariae: round or ovate. Diameter 300-400 m, 1-3 layers of cyst wall 并殖吸虫病Paragonimia5 Life Cycle Man with adult worm to mature passing eggs into water 2-3months 21 days eating miracidi Metacercaria first intermediate host(special snail) second intermediate host 3 months

4、 (crayfish and freshwater crab) cercaria 并殖吸虫病Paragonimia6 Epidemiology w Source of infection: humans mammals and other worm carriers, which can produce eggs w Route of transmission: 1.The presence of the final host:patients and the infected mammals 2.The presence of a large amount of 1st and 2nd in

5、termediate host 3.The habit of eating the freshwater crayfish and crab w Susceptibility: every one is susceptive 并殖吸虫病Paragonimia7 Character of Epidemic w Widely distributed: Asia, Africa, America in our country, more than 21 provinces are involved in the infection w It mainly occurs in summer and a

6、utumn w North:the type of crayfish epidemic South:the type of freshwater crab epidemic 并殖吸虫病Paragonimia8 并殖吸虫病Paragonimia9 Process Caused by Juvenile Worms w Metacercariae excyst in duodenum, and into abdominal cavity, the migrate cause mechanical lesions w Penetrate diaphragms into pleural cavity t

7、o cause lung cyst w The pathological change caused by pagumogonimus skjabin include :subcutaneous nodules mass, exudative pleurisy , liver lesion, and eosinophilia. The typical lesion are eosinophilous granulomas 并殖吸虫病Paragonimia10 Process Caused by Adult Worms w Inhabit lungs w Migrate through lace

8、rated foramen into cranial cavity, invade into the brain w Invade into greater psoas muscle w Migrate through intervertabral foramen into epidural cavity w All these causing space occupying lesion 并殖吸虫病Paragonimia11 Process Caused by Eggs w The reaction is slight 并殖吸虫病Paragonimia12 Basic Pathologica

9、l Lesion w The process are divided into three stages: w Abscess stage: the worms migrate from intestine to lung, result in hemorrhage necrosis of the tissue, macrophages, eosinophils and neutrophile are aggregated causing eosinophilous abscess w Cyst stage:the worms provoke a granuloma reaction that

10、 gradually proceed to develop fibroid encapsulation w Fibrosis and scar stage:the internal material are excreted or absorbed, consequently proliferation of the fibrous tissues 并殖吸虫病Paragonimia13 Clinical Manifestation w Incubation period: 3-6 months w The onset is insidious, most slight and moderate

11、 infections are asymptoms w In severe infection, the clinical manifestations are complex 并殖吸虫病Paragonimia14 Clinical Manifestations w Systemic symptoms: chills, slight fever, weakness, headache, chest pain, night sweat. Some patients have urticaria and asthma. Eosinophilia is common w Respiratory sy

12、mptoms: the involvement of the lung are characterized by: rusty sputum, chest pain, coughing, hymoptysis, expectoration, hydrothorax, eggs can be found in the sputum w Abdominal symptoms: general abdominal pain, diarrhea, nausea, vomit, and hepatomegaly.asites, intestinal adherence and obstruction o

13、ccur in severe infection 并殖吸虫病Paragonimia15 Clinical Manifestation w Nervous system symptoms: the symptoms are complicated due to the variation of the location of the worms: w Brain: Intracranial hypertension Damage of the brain tissue Abnormal stimulation of brain tissue: Inflammation w Spine: dysc

14、inesia and sensory disturbance below the ridden area of the spine 并殖吸虫病Paragonimia16 Clinical Manifestation w Subcutaneous nodules and masses: at any part of the body, mainly abdomen, chest and backside. Always migratory w Other symptoms: w Differentiation of manifestation between paragonimus wester

15、mani and pagumogonimus skjabin are on page 227 of our textbook 并殖吸虫病Paragonimia17 Laboratory Findings w General examination: in blood routine test, WBC raise to 10-40 G/l, and more than 80% may be eosinophils. ESR fasten w Pathogen examination: Sputum:eggs, eosinophils and Charcot-Leyden crystal may

16、 be found. The positive rate of finding eggs can reach 90% Stool: the eggs come from sputum swallowed, the positive rate is 15-40% Biopsy of subcutaneous nodules and masses: typical eosinophilous granuloma with eggs, larvae and adult worm 并殖吸虫病Paragonimia18 Laboratory Findings w Immunological test:

17、Intracutaneous test ELISA Dot-ELISA and Weston blot IHA and RIA etc. w X-ray Chest examination: CT Brain vascular and spine photography 并殖吸虫病Paragonimia19 Diagnosis w Epidemiologic date: history of eating raw or pickled freshwater crab or crayfish w Clinical manifestation: cough, rusty sputum, migra

18、tory subcutaneous nodules and masses epilepsy, headache and paralysis w Laboratory findings: Finding eggs or worms Immunological test 并殖吸虫病Paragonimia20 Differential Diagnosis w Tuberculosis : tubercular pleurisy or peritonitis w Brain tumor and other brain parasitosis w Viral hepatitis 并殖吸虫病Paragonimia21 Prognosis w Because the species, the location and the degree of infection are different, the prognosis is difference. w The prognosis are usually good w The prognosis of cerebrospinal type is bad 并殖吸虫病Paragonimia22 并殖吸虫病Paragonimia23 Pathogen Treatment w Praziquan