寄生虫医学课件：plasmodia2015双语(m)

1、Prof. Huanhuan Shi,Malaria Parasite,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 Plasmodium vivax P.v.,恶性疟原虫 P. falciparum P.f.,三日疟原虫 P. malariae P.m.,卵形疟原虫 P. ovale P.o.,世界性 分布 (国内、广西常见）,主要分布于国外,Viva

2、x malaria,Quartan,Ovale malaria,falciparum malaria,Malaria is one of the major public health challenges eroding development in the poorest countries in the world.,Why worry about malaria?,Malaria makes the poor even poorer,Malaria costs Africa more than US$ 12 billion annually. It has slowed economi

3、c growth in African countries by 1.3% per year,Morphology,Anopheles,Human body,Morphology,In blood smears stained by Giemsas, Plasmodia cytoplasm were stained as light blue color and nuclear chromatin red color, while cytoplasm of the infected erythrocyte stains pink color.,RBC（pink）,Nuclear （red or

4、 purple）,Cytoplasm （light blue）,Pigment,Schuffners dots,Erythrocytic stages of P.v,Ring form,Large trophozoite,immature schizont,mature schizont,microgametocyte,macrogametocyte,Erythrocytic cycle,merozoite,Erythrocytic stage,Ring form 环状体,Amoeboid,Trophozoite 大滋养体,Erythrocytic stage,Immature Schizon

5、t 未成熟裂殖体,mature schizont 成熟裂殖体,Erythrocytic stage,Formation of gametocyte,Microgametocyte 雄配子体,Macrogametocyte 雌配子体,Formation of gametocyte,Ring form,Erythrocytic stages of P.f,macrogametocyte,microgametocyte,Large trophozoite and schizont of P.f. are seldom seen in peripheral blood.,Ring form,gamet

6、ocyte,Comparison between P.v and P.f,Ring form,Large trophozoit,schizont,gametocyte,P.v,P.f,Seldom seen in peripheral blood,Life cycle,Anopheles,Human body,子孢子,速发型,迟发型,红外期 8 d,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.7

7、2h P.f. 48h, P.o 48h,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,

8、隐匿期,6-12个月（P.V迟发型）,速发型,The Process of malarial infection,Include: incubation period, first paroxysm, recrudescence and relaps.,Incubation period 潜伏期,The incubation period represents the interval between the bite of infecting mosquito and onset of clinical symptoms. It is the duration of preerythrocy

9、tic period and the time of erythrocytic parasities multiplying sufficiently to the liminal value that is able to produce clinical symptoms.,Incubation: P.v.-transmitted by mosquito : around 14 d. transmitted by blood transfussion : around7 d long incubation: 6m-12m. P.f.-transmitted by mosquito : ar

10、ound 11d.,Malarial paroxysm,Fever with tertian periodicity in vivax malaria,Blood stage parasites are responsible for the clinical manifestations of the disease.,Symptoms of malaria typically consist of definite paroxysms of chills, fever and sweating.,疟疾发作,Higher sympathetic excitability,Merozoites

11、, metabolites of malaria parasite , denatured hemoglobin and fragment infected RBC,stimulate,Nerve center that controls temperature,Mechanism of paroxysm,Fever,Exogenous or endogenous pyrogen,Typical manifestation,Chill 寒战,High fever 高热,Sweating 出汗退热,30 - 60min,3- 4 h,2-3h,Fever with tertian periodi

12、city in vivax malaria 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,=,A victim of Highland Malaria at TransMara Medical Center,A young girl with Highland Malaria waiting for medicine at Shankoe,Malaria patients,Recrudescence 再燃,Recrudescence is the recurrence of symptoms after a tempor

13、ary abatement(some days or weeks). P. falciparum is the usual cause of recrudescent infections and these arise 2-4 weeks following treatment. Reasonmalaria parasites remained in RBC multiply again.,Relapse is the return of a disease after its apparent cessation. Both P. vivax and P. ovale have a ten

14、dency to relapse after resolution of the primary infection. Relapses occur weeks or months after the primary infection. Reasonbradysporozoites stayed in hepatic cell multiply.,Relapse 复发,Cerebral malaria (CM)脑型疟 -Severe Falciparum Malaria CM, life-threatening malaria is nearly always caused by P. fa

15、lciparum. The symptoms are very serious, such as Lasting high temperature (40-41C), unconsciousness and shock. High mortality Overall mortality in treated cerebral malaria in reported studies averages 15% in children and 20% in adults (but up to 50% in pregnancy),My head hurts so much,1.Anemia REASO

16、N * Destruction of erythrocytes parasitized * Enhancement of spleen function * Depression of marrow function * Immunopathological mechanisms,complications,2. Hepatosplenomegalia,Enlarged liver and spleen (below navel),Hyperplasia of reticuloendothelial system,Reason:,3. Malaria nephritis 疟疾肾病 多见于P.m

17、 感染的慢性病人 4. Fever with dark urine 黑尿热 常见于G6PD缺乏者服用伯喹等药物引起,Laboratory diagnosis,Thin or thick blood film 1 .Collection of blood: peripheral blood smears 2. Giemsa or Wrights staining 3. Examination under microscopy,Laboratory diagnosis,Taking finger(or ear lobe) prick blood for malaria test,A doctor

18、takes a blood smear from a baby,Laboratory diagnosis,A hospital worker examining a blood smear,Immunodiagnosis 1)Detection of an antigen 2)Detection of antibodies Molecular diagnosis Polymerase-chain rection (PCR),Laboratory diagnosis,Molecular Diagnosis,Lane S: molecular base pair standard (50-bp l

19、adder). Black arrows show the size of standard bands. Lane 1: P. vivax (size: 120 bp) Lane 2: the red arrow shows the P. malariae (size: 144 bp) Lane 3: P. falciparum (size: 205 bp) Lane 4: P. ovale (size: 800 bp),Laboratory diagnosis,Epidemiology & control,Distribution Malaria is probably the most

20、widespread of all diseases. P. vivax is widespread in the tropics and sub-tropics, and in some temperate regions. P. falciparum is found most commonly in warm moist climates. P. malariae occurs throughout the tropics. P. ovale is uncommon.,Epidemiology,Geographic Distribution,根据世界卫生组织发布数据，全球86的疟疾病例发

21、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

22、、江苏、湖北等中部地区。,Source of infection.,The patients or carriers whose blood contains mature gametocytes.,Mosquito vectors,Anopheline mosquitoes are the vectors of malaria,In China: A. sinensis 中华按蚊 minimus 微小按蚊 A. anthropophage 嗜人按蚊 A. dirus 大劣按蚊,Epidemiology,Susceptible persons,Epidemiologic factors,The epidemiology of malaria is influenced by the climate, topography, socio-economic status o