【优选】阿米巴病PPT文档

DISTRIBUTIONAmebahasworldwidedistributionbutismostcommonincentralandsouthAmerica,southernandwesternAfrica,thefareast,andtheIndia

>10%oftheworld’spopulationisinfected.Thesecondleadingcauseofdeathfromparasitedisease1Etiology4speciesofEntamoeba:E.hartmanniE.coli

(Pathogenic)E.dispar(asymptomatic)

intestines2EntamoebahistolyticaOneofthemostimportantandpathogenicparasitesofhumans50millioncaseseveryyear,100,000died34Microbiology2forms：trophozoite;cyst

Lifecyclecystpostcysttrophozoiteprecyst5EntamoebahistolyticaTrophozoites6EntamoebahistolyticaDormant/resistantstageSpherical1-4nuclei,(4inmaturecysts)Bluntlyroundedchromatoidalbars7EntamoebahistolyticaCysts8EntamoebahistolyticaCysts

UninucleatecystBinucleatecyst9EntamoebahistolyticaCysts

Quadrinucleateormaturecysts10Epidemiology11LifeCycle12EntamoebahistolyticaPathogenesisE.histolyticatrophozoitesCytolyticenzymesandpseudopodinvadecolonictissueFlaskshapedsubmucosalulcerationsformMaycauseamebicliverabscess,bleeding,perforation,peritonitis13EntamoebahistolyticaPathology1.APrimaryUlcerOccur14EntamoebahistolyticaPathology1.APrimaryUlcer：

Histolysisnecrosis

15EntamoebahistolyticaPathologyExtra-IntestinalLesionsandAbscessOccursHepaticAmebiasisB.PulmonaryAmebiasisC.CerebralAmebiasis16Incubationperiod:1~3weeks,4d~1y

Typicalamebacolitis:

Fulminantcolitis:

Asymptomatictype:

Chroniccolitis:

Extraintestinalamebiasis:ClinicalManifestations17ClinicalManifestations

Typicalamebacolitis:Dysentery(mucousandblood)strawberryjamstool,<10times/dayNofeverAbdominalpain(rightlowerquadrant)TenesmusMalaise,anorexia,weightloss18ClinicalManifestations

Fulminantcolitis:rare,inchildrenToxicFeverProfusebloodymucoiddiarrheaHypotentionPeritonitisMortalityis50%19ClinicalManifestations

Asymptomatictype:>90%FewornosymptomsDischargecystsResolveswithouttreatmentRelapsesandreinfectionarecommon20ClinicalManifestations

Chroniccolitis:>1yearIntermittentdiarrhea,mucusConstipationAbdominalpainFlatulenceWeightloss,neurastheniasymptoms,anemia21ClinicalmanifestationsExtraintestinalamebiasis:LiverLungBrainOtherorgans22ComplicationsEnterorrhagiaIntestineperforationAppendicitisAmoebomaRectumfistulaAmebicliverabscessOtherorgansinvolvement23Diagnosis

Epidemiologicaldata:Clinicalmanifestations:IntestinalsymptomsWholebodysymptomsLaboratoryfindings:

findcystortrophozoitesinthestool24Laboratoryfindings

BR:normalleukocytecount

Fecalmicroscopy

ELISA:87%sensitivity,90%specifity

PCR:

87%sensitivity

SerologicalTest:

antibodiestoameba

Endoscopy:

25FollowedbyluminalagentgradualonsetHepaticAmebiasisCystsresistanttochlorine,killedbyboilingwaterandiodineAmebicliverabscessFollowedbyluminalagentabdominalpain—rightshoulderEffectivesanitationandcleanwatersupplyAnti-amebictherapy,surgeryEntamoebahistolyticaCystsEntamoebahistolyticaCystsLargevolum,Jam-likestool,fume;lessWBCandlotofRBC,Charcot-Leydencrystals,trophozoite,noShigellaTypicalamebacolitis:AspirationifnecessaryBacterialliverabscesscytolyticenzymesDifferentialDiagnosis

ShigellosisSchistosomiasisColonicTBandcarcinomaRectalcancerBacterialfoodpoisoningcholera26Generaltreatment:

Rest,easydigesteddietCorrectionoffluidandelectrolyteunbalanceReliefabdominalpainTreatment27TreatmentAnti-amebictherapy:AsymptomaticcystpassageIntestinaldiseaseFirstchoiceLuminalagent—diloxanidefuroate,500mgPOTid×10dORLodoquinol,650mgPOTid×20dMetronidazole,750mg

POTid×10dFollowedbyluminalagentalternativeTetracycline,250mgTid×10dORTinidazole,50mg/kgPOTid×10d28TreatmentAspiration:

Noclinicalresponsetodrugtherapywithin5-7d,AbscessruptureSurgicaltreatment:

Abscessrupture,Consequentperitonitis29CorrectionoffluidandelectrolyteunbalanceGeneraltreatment:IntestinalsymptomsSurgicaltreatment:FollowedbyluminalagentUninucleatecystBinucleatecystFulminantcolitis:rare,inchildrenExtraintestinalamebiasis:LiverhydatiddiseaseDifferentialdiagnosisDISTRIBUTIONDormant/resistantstageExtraintestinalamebiasis:BacterialliverabscessUninucleatecystBinucleatecystDischargecystsAsymptomatictype:Epidemiologicaldata:ComplicationtreatmentEnterorrhagia:

FluidandbloodtransfusionIntestineperforation:

Anti-amebictherapy,surgeryAppendicitis:

Anti-amebictherapy,surgery30AmebicLiverAbscess31Pathogenesisandpathology

E.histolyticatrophozoitesportalvein

pseudopodiaamebicliverabscesslivertissuecytolyticenzymesruptureperitonitis32Movementoftrophozoitesfromlargeintestinetoliverviahepaticportalvein.LiverAbscesses33gradualonsetabdominalpain—rightshoulderhighfever,coughanemia,nausea,fatigueloseofappetiteandbodyweight

ClinicalManifestations34ComplicationBronchohepaticfistulaPeritonealamebiasisPericardialinvolvementSecondaryinfection35

EpidemiologicaldataEatinghabit,historyofdiarrhea

Clinicalmanifestations

LaboratoryfindingsLiquefiedspace-occupyinglesion,specificantibodies,ultrasoundB,acupunctureDiagnosis36LiverBiopsyCTscan37AmebicLiverAbscess38BacterialliverabscessCongenitallivercystPrimaryhepatocellularcarcinomaLivermetastasisofcarcinomasLiverhydatiddiseaseLivertuberculosisDifferentialdiagnosis39

Supportivetreatment

Symptomatictreatment

Etiologicaltreatment

AspirationifnecessaryTreatment40PreventionProphylacticmeasuresEffectivesanitationandcleanwatersupplyCystsresistanttochlorine,killedbyboilingwaterandiodineTravelerstoendemicareasshouldavoidunpeeledfruitsandvegetablesanduntreatedwaterIsolationprecautionsVaccines