医学寄生虫学课件：5-trematodes

2023/5/311

Medicalarasitology2023/5/3112023/5/312Announcementofthe2015NobelPrizeinPhysiologyorMedicine2023/5/31232023/5/3133屠呦呦2023/5/31444YouyouTuBorn:1930,ZhejiangNingpo,ChinaAffiliationatthetimeoftheaward:ChinaAcademyofTraditionalChineseMedicine,Beijing,ChinaPrizemotivation:"forherdiscoveriesconcerninganoveltherapyagainstMalaria"Prizeshare:1/2455SatoshiŌmuraBorn:1935,Yamanashiprefektur,JapanAffiliationatthetimeoftheaward:KitasatoUniversity,Tokyo,JapanPrizemotivation:"fortheirdiscoveriesconcerninganoveltherapyagainstinfectionscausedbyroundwormparasites"Prizeshare:1/4566WilliamC.CampbellBorn:1930,Ramelton,IrelandAffiliationatthetimeoftheaward:DrewUniversity,Madison,NJ,USAPrizemotivation:"fortheirdiscoveriesconcerninganoveltherapyagainstinfectionscausedbyroundwormparasites"Prizeshare:1/462023/5/317TrematodesFlukesTrematode(Fluke)2023/5/318Morphology

Leaf-shaped,flattened(exceptSchistosome),withoutbodycavity,OralsuckerandVentralsuckerHermaphroditic(exceptSchistosome)schistosome2023/5/319Lifecycle

Intermediatehostrequired,Sexualgeneration,asexualgeneration,Snail----------firstintermediatehostAdulteggmiracidiumsporocyst

redia(I,II)EncystedAdolescariametacercariacercariaPaedogenesisthereproductioninaneotenizedstate2023/5/3110Larvaeofflukemiracidiumsporocystrediacercariacercariametacercaria2023/5/3111Somefeatures:DevelopmentinaquaticRequiremulti-hostIntermediatehost:aquaticanimalPaedogenesisandpolyembryonicproliferation

inlifecycleVisceralflukes2023/5/31122023/5/3113Clonorchissinensis“Chineseliverfluke”(Coursingchlonorchiasis)

longhistoryFood-borneparasitosis(parasiticdisease)severelyepidemicinChina,KoreaLonghistory2023/5/3114Itwassaidthattheprevalenceofclonorchiasishascontinuedformorethan2300years2023/5/3115Currentlyinfectinganestimated30,000,000humans，85%ofcasesarefoundinChina.2023/5/311612.49millionspeopleinfected2023/5/3117Morphology1.Adultwormsunflowerseedsized

10-25mm×

3-5mm2023/5/31182023/5/3119Egg

convexoperculum

miracidium

shellcomma-protuberanceTheterminalknobisnotalwaysvisibleEggFlask-shaped,relativelysmallerinsize,17×29umshoulder2023/5/3120Adulteggmiracidium(inbiliarypassagesofsporocystliver)rediaencystedAdolescariaemetacercariaecercariaIngestedbysnailEscapefromsnailpenetratefreshwaterfish,shrimps,intheirmusclesProduce5-50IngestedbymanoranimalsEnterthebileductthroughtheAmpullaofVater.Adultlifespan:20-30yearsFreshwatersnailsLifecycle2023/5/3121Lifecycle2023/5/3122Somefeaturesoflifecycleadultslivinginbileductstwointermediatedhostsneeded:freshwatersnailsfreshwaterfish,shrimpsPaedogenesis

reservoirhost：cat,caninesinfectionbymouthlifespanofadult:morethan20years

Parafossarulusstriatulus,Bithyniafuchsianus2023/5/31232023/5/3124

Pathogenesis

1.Adolescaria

allergy

eosinophilia

2023/5/31252.Adult

basicpathogenesisoftheinfection（1）erosionoftheepitheliumliningthebileducts,cholangitis,thenproliferation,progressiveportalfibrosishepatocirrhosis（2）biliarytractblockage

jaundice

（3）cholelithiasis（4）carcinomaDwellinginthebileducts,Clonorchisinducesaninflammatoryreaction,epithelialhyperplasiaandsometimesevencholangiocarcinoma,theincidenceofwhichisraisedinfluke-infestedareas.2023/5/3126Clinicsymptoms：Acute:Fever,chills,abdominalpain,diarrhea,tenderhepatomegaly,Mildjaundice.Chronic:Fatigue(26.3%),upperabdominaldiscomfort(24.1%),abdominalpain(23.1%),dizziness(19.3%),hapatomegaly(52%),andsplenomegaly(1.2%)occursonetothreeweeksaftertheingestionofencystedmetacercariaeClinicalmanifestationsusuallydevelopinthechronicstage,whenpathologicchangestakeplaceinthehepatobiliarysystemEndoscopyrevealsadultClonorchissinensiswithinintrahepaticbileduct.2023/5/31272023/5/3128ChronicComplications:

pancreatitis,cholangiocarcinoma,cholelithiasisdwarfismenhancedsusceptibilityto2023/5/3129

Diagnosis

1.Stoolexamination

Fecalsmear,

sedimentationmethod

2.Duodenalaspiration,(inhospital)

3.

Enterotestcapsule(inhospital)

4.Immuno-diagnosisELISA,IHA,

5.Image:Supersonicwave,computedtomograph

DrainagetubeAgastricstringtestusingacapsulecontaininga90cm-longnylonfiberwasperformed.Beforethecapsulewasswallowed,thefreeendofthestringwastapedtothecheek.Afteronehourinthestomach,thestringwaswithdrawn.2023/5/3130Epidemiology1.GeographicDistribution

EndemicareasareinAsiaincludingKorea,China,Taiwan,andVietnam.

2.Epidemiology(1)Sourcesofinfection

patient

reservoirhosts:Guandong,Guanxiprovinces2023/5/3131

(2)

IntermediatehostFreshwatersnailsFreshwaterfishes

2023/5/3132(3)Themodeofrearingfishes：Thelatrinesnearbyfishponds

2023/5/3133（4）Dieteticcustom：

rawfish

Rawfishporridge

2023/5/3134Susceptiblepopulation：teenagers2023/5/31352023/5/3136Preventionandtreatment

1.Dietetichygiene2.Tablewarehygiene3.Don’tusefreshstooltofeedfish4.Chemotherapy

Praziquantel×Casestudy

2023/5/3137A29-year-oldwomanpresentedbecauseofrightupperquadrantdiscomfort,malaiseanddarkurine.ShewasborninVietnam,marriedanAmericanserviceman,andcametotheUS.Shestatesthatonseveraloccasionsshehasexperiencedboutsof“yellowjaundice”withdarkurineandabdominaldiscomfort.Theseepisodesfirststartedwhenshewasabout20yearsold.Althoughthesewereinfrequentatfirst,overthepastyearshehashadfoursuchepisodes,andthishasbecomealarmingtoherhusband.Shedrinksabout4martinisaweek.Shedeniedweightloss,anorexia,nauseaorvomiting.2023/5/3138Laboratory:WBC:11800,HepatitisBsurfaceantigennegativeStoolforovaandparasitesQuestions2023/5/3139Whatisyourdiagnosis?Howdidsheacquireherdisease?ComplicationsthatcanoccurwiththisinfectionincludeWhattreatment,ifany,wouldyougivethiswomanIntestinalflukes

2023/5/31402023/5/3141Fasciolopsis

buski

CausingFasciolopsiasisThelargestone2023/5/3142Distribution2023/5/3143

Adult:20to75mminlength,8to20mmindiameter,Flatandfleshworm,reddish-beef-color,MorphologyLookslikecoral

2023/5/3144Egg2023/5/3145paleyellowish,asmalloperculum,thelargesteggofhelminths

(130to140by80to85um)2023/5/3146Lifecycle

Adulteggsmiracidiumsporocyst(LiveinsmallIntestine)rediaIrediaIIMetacercariaecercariaerediaIIIHatchinwaterat26~32C,3~7weeksPenetrateintothesnail,PlanorbiidEscapefromsnail,andencystonunderwatervegetationswhichasamediumfortransportIngestedbyhumanandpig2023/5/31472023/5/3148Charactersoflifecycle：1、livinginintestinal2、intermediatehost:aquaticPlanorbiid3、infectivestageadheretothesurfaceofaquaticplants5、aquaticplant:chestnut,watercaltrop,6、reservoirhost:pigs7、adultlifespan:1year2023/5/3149chestnut,watercaltrop

Vegetationsoraquaticplants2023/5/3150OtherplantsduckweedsLotusWaterbamboo2023/5/3151

Pathogenesis

digestivesystem:diarrheawithhungerpains,pepticulcer,weightloss,edema,andanemia

diarrheainitiallymayalternatewithconstipationeosinophilia,asthenia,stuntedgrowth.

Diagnosis

fecalexamination,sedimentationmethodInendemicareas,adultwormsoccasionallyareseeninthefecesaswellMostinfectedpersonsaresymptomatic2023/5/3152

Epidemiology

InOrient,18provincesinChinainfectiveways：eatingrawplants,Human----------pigcycleDrinkwaterControlPraziquantelThroughcookingofaquaticplantCasereport2023/5/3153A39-year-oldfemalefarmer,anativeofSabah(EastMalaysia).Thispatientcomplainedofcoughandfeverforadurationoftwoweeks,associatedwithlossofappetiteandlossofweight.Shehadnohistoryoftravelingoverseas.Physicalexaminationshowedpallor,multiplecervicalandinguinallymphnodesandhepatosplenomegaly.Laboratoryinvestigationsshowedthatshehadirondeficiencyanemia.2023/5/3154TherewasleukocytosisandaraisedESR.Lymphnodebiopsyrevealedacaseatinggranuloma.StoolexaminationwaspositivefortheeggsofFasciolopsisbuski.Theeggsmeasure140x72.5μmandareoperculated.Inthiscase,thepatientdidnotpresentwithsymptomssuggestiveofanyintestinalparasiticinfections.DetectionofFasciolopsisbuskieggsinthestoolwasanincidentalfinding.Shewasdiagnosedasacaseofdisseminatedtuberculosiswithfasciolopsiasisandwastreatedwithantituberculosisdrugsandpraziquantel,respectivelyerythrocytesedimentationrate

Question2023/5/3155Ifyouaredoctor,whatsuggestionthatpreventthisdiseaseyoupresenttothispatient?Lungflukes2023/5/3156

Paragonimuswestermani

(lungfluke,Orientallungfluke)

paragonimiasis

2023/5/31572023/5/3158Foodborneparasiticdisease

ingestionofrawcrab

andcrayfish2023/5/31592023/5/31602023/5/31612023/5/3162Morphology

1.Adult：

7.5mm-12mm×4mm-6mm

Thick,plump,fleshy,reddishbrownincolor,Twolobatedtestes,ovarylobated.2023/5/3163

2.Egg

2023/5/3164polymorphism,golden-brown,oval-size,flattenedoperculum，thinshell,oneeggcellandnumberofyolkcells.Anobviousterminalshellthickeningislocatedontheendoppositetheoperculum.Lifecycle2023/5/3165Adulteggmiracidiumsporocyst

inlung

rediaIlifespan:6~7years

rediaIIAdolescariaemetacercariaecercariae

ectopiclocations

InsputumorfecesInwater3weeksPenetratesnail(familymelaniidae)EscapefromsnailandinvadethetissuesofcrayfishorcrabandencystIngestedbyman,carnivoresReachingtheabdominalcavityandthroughthediaphragmtopleuralcavityandlungsInvolvingmanyInternalorgansYounglarvaecanmigrateintomultipleinternalorgansLifecycle2023/5/31662023/5/3167Familymelaniidae2023/5/3168crayfishcrabmetacercariaeCharacteristicsoflifecycle2023/5/3169Infectivestage:metacercariaFirstintermediatehost:freshwatersnailSecondintermediatehost:crab,crayfishDefinitivehost:human,canine,cat,andcarnivoresMajorreservoirhost:canine,cat.InfectionbymouthYounglarvaecanmigrateintomultipleinternalorgans(adolescariae)Pathogenesis2023/5/31701、AcutestageCausedbyinvasionandmigrationoftheyoungflukes,symptomsinclude:fever,diarrhea,abdominalpain,chestpain,cough,eosinophilia.2.、ChronicstageStageofabscess;destructionandhemorrhageoftissue,leukocytesinfiltrate,abscessisformed

Stageoffibrouscyst:thegranulomatissuesarestimulatedtoproliferateandform“wormcyst”

Stageoffibrousscar:emptycystwillbefilledwithfibrousscar2023/5/31712023/5/31722023/5/3173Clinicpresentations2023/5/3174Thisdisease:involvingmulti-organsbesideslung

1）Pulmonarysymptoms

pleuralpain,exertionaldyspnea,morningcough,“rustysputum”,fever.2）Extra-pulmonarylesion：Inabdominalform:pain,diarrhea,hemafecia.Inbrainform:headache,focalseizures,epilepsy,paralysis,visualdisturbances.Inskinform:abscesses,migratorynodulesInliver:symptomslikehapetitisRaresitesofinfection:lymphnodes,breast,kidney,liver,spleen2023/5/3175WBCelevateEosinophilsextremelyhigh

eosinophiliatheimportantfeature2023/5/3176Brainformwithparagonimiasis2023/5/3177Brainformofparagonimaisis(hemiplegia)2023/5/3178Abdominalform2023/5/3179EyeformAbdominalform2023/5/3180IntestinalParagonimiasiswithColonicUlcerandHematocheziainAnElderlyTaiwaneseWomanDiagnosis2023/5/3181

HistoryTypicalclinicsymptomsLaboratorydiagnosis

1)Sputumdetection：

directlysmearCharcot—Leydencrystals

2023/5/31822)

Fecalsmearsedimentation3)Skinbiopsy2、Immunologicmethods3、Molecular-biologicaldiagnosis4、Imagechest/CT,x-ray,MR.5、Bloodtest

inbloodWBC

>20,000/mm3E>30-40%

Epidemiology2023/5/3183DistributioninsoutheastAsiaandJapan

Epidemiologicalfeatures：

Definitivehosts:canine,cat,felidParatenichost:pigorwildpigNaturalfocusandparasiticzoonosisFirstandsecondintermediatehostsThewayofacquiringinfection:ingestionofrawcra