并殖吸虫病Paragonimiasis课件

IntruductionAkindofchronicdiseasecausedbyparagonimuswestermani,paragonimusszechuanensisandseveralotherrelatedspeciesAdultwormofparagonimuswestermaniinhabitlungsofthefinalhost,causingcough,chestpain,rustysputumandhemoptysisparagonimusszechuanensiscausesubcutaneousnodulesandmassesInfectedbyeatingrawcrayfishandfreshwatercrabIntruductionAkindofchronic1EtiologyEtiology2MorphologyAdultworm:theyaremonoecious,thereproductiveorgansareparallel,havetwosuckersEggs:goldenbrown,ovate,operculate,thesizeis80-120×48-60mMetacercariae:roundorovate.Diameter300-400m,1-3layersofcystwallMorphologyAdultworm:theyare3LifeCycleManwithadultwormtomaturepassingeggsintowater2-3months21dayseatingmiracidiMetacercariafirstintermediatehost(specialsnail)secondintermediatehost3months(crayfishandfreshwatercrab)cercariaLifeCycleManwithadultworm4EpidemiologySourceofinfection:humansmammalsandotherwormcarriers,whichcanproduceeggsRouteoftransmission:

1.Thepresenceofthefinalhost:patientsandtheinfectedmammals2.Thepresenceofalargeamountof1stand2ndintermediatehost3.ThehabitofeatingthefreshwatercrayfishandcrabSusceptibility:everyoneissusceptiveEpidemiologySourceofinfectio5CharacterofEpidemicWidelydistributed:Asia,Africa,Americainourcountry,morethan21provincesareinvolvedintheinfectionItmainlyoccursinsummerandautumnNorth:thetypeofcrayfishepidemicSouth:thetypeoffreshwatercrabepidemicCharacterofEpidemicWidelydi6PathogenesisandPathogenPathogenesisandPathogen7ProcessCausedbyJuvenileWormsMetacercariaeexcystinduodenum,andintoabdominalcavity,themigratecausemechanicallesionsPenetratediaphragmsintopleuralcavitytocauselungcystThepathologicalchangecausedbypagumogonimusskjabininclude:subcutaneousnodulesmass,exudativepleurisy,liverlesion,andeosinophilia.ThetypicallesionareeosinophilousgranulomasProcessCausedbyJuvenileWor8ProcessCausedbyAdultWormsInhabitlungsMigratethroughlaceratedforamenintocranialcavity,invadeintothebrainInvadeintogreaterpsoasmuscleMigratethroughintervertabralforamenintoepiduralcavityAllthesecausingspaceoccupyinglesionProcessCausedbyAdultWormsI9ProcessCausedbyEggsThereactionisslightProcessCausedbyEggsThereac10BasicPathologicalLesionTheprocessaredividedintothreestages:Abscessstage:thewormsmigratefromintestinetolung,resultinhemorrhagenecrosisofthetissue,macrophages,eosinophilsandneutrophileareaggregatedcausingeosinophilousabscessCyststage:thewormsprovokeagranulomareactionthatgraduallyproceedtodevelopfibroidencapsulationFibrosisandscarstage:theinternalmaterialareexcretedorabsorbed,consequentlyproliferationofthefibroustissuesBasicPathologicalLesionThep11ClinicalManifestationIncubationperiod:3-6monthsTheonsetisinsidious,mostslightandmoderateinfectionsareasymptomsInsevereinfection,theclinicalmanifestationsarecomplexClinicalManifestationIncubat12ClinicalManifestationsSystemicsymptoms:chills,slightfever,weakness,headache,chestpain,nightsweat.Somepatientshaveurticariaandasthma.EosinophiliaiscommonRespiratorysymptoms:theinvolvementofthelungarecharacterizedby:rustysputum,chestpain,coughing,hymoptysis,expectoration,hydrothorax,eggscanbefoundinthesputumAbdominalsymptoms:generalabdominalpain,diarrhea,nausea,vomit,andhepatomegaly.asites,intestinaladherenceandobstructionoccurinsevereinfectionClinicalManifestationsSystemi13ClinicalManifestationNervoussystemsymptoms:thesymptomsarecomplicatedduetothevariationofthelocationoftheworms:Brain:IntracranialhypertensionDamageofthebraintissueAbnormalstimulationofbraintissue:InflammationSpine:dyscinesiaandsensorydisturbancebelowtheriddenareaofthespineClinicalManifestationNervous14ClinicalManifestationSubcutaneousnodulesandmasses:atanypartofthebody,mainlyabdomen,chestandbackside.AlwaysmigratoryOthersymptoms:Differentiationofmanifestationbetweenparagonimuswestermaniandpagumogonimusskjabinareonpage227ofourtextbookClinicalManifestationSubcutan15LaboratoryFindingsGeneralexamination:inbloodroutinetest,WBCraiseto10-40G/l,andmorethan80%maybeeosinophils.ESRfastenPathogenexamination:

Sputum:eggs,eosinophilsandCharcot-Leydencrystalmaybefound.Thepositiverateoffindingeggscanreach90%

Stool:theeggscomefromsputumswallowed,thepositiverateis15-40%

Biopsyofsubcutaneousnodulesandmasses:typicaleosinophilousgranulomawitheggs,larvaeandadultwormLaboratoryFindingsGeneralexa16LaboratoryFindingsImmunologicaltest:

IntracutaneoustestELISADot-ELISAandWestonblotIHAandRIAetc.X-ray

Chestexamination:CTBrainvascularandspinephotographyLaboratoryFindingsImmunologic17DiagnosisEpidemiologicdate:historyofeatingraworpickledfreshwatercraborcrayfishClinicalmanifestation:

cough,rustysputum,migratorysubcutaneousnodulesandmassesepilepsy,headacheandparalysisLaboratoryfindings:FindingeggsorwormsImmunologicaltest

DiagnosisEpidemiologicdate:18DifferentialDiagnosisTuberculosis:tubercularpleurisyorperitonitisBraintumorandotherbrainparasitosisViralhepatitisDifferentialDiagnosisTubercu19PrognosisBecausethespecies,thelocationandthedegreeofinfectionaredifferent,theprognosisisdifference.TheprognosisareusuallygoodTheprognosisofcerebrospinaltypeisbadPrognosisBecausethespecies,20TreatmentTreatment21PathogenTreatmentPraziquantelisthebestchoiceofdrugfo