肺吸虫病精品.ppt

并殖吸虫病（肺吸虫病）并殖吸虫病（肺吸虫病）paragonimiasis中国医科大学附属盛京医院感染科中国医科大学附属盛京医院感染科概述概述Ø寄生于人体内脏器（肺部为主）或皮下组织的并殖吸寄生于人体内脏器（肺部为主）或皮下组织的并殖吸虫所致的一种慢性寄生虫病虫所致的一种慢性寄生虫病Ø人吞食含有并殖吸虫活囊蚴的溪蟹或喇蛄而感染人吞食含有并殖吸虫活囊蚴的溪蟹或喇蛄而感染Ø临床表现：卫氏并殖吸虫引起以肺部病变为主的全身临床表现：卫氏并殖吸虫引起以肺部病变为主的全身性疾病，主要表现为咳嗽、咳铁锈色或烂桃样痰、咯性疾病，主要表现为咳嗽、咳铁锈色或烂桃样痰、咯血等，称肺吸虫病斯氏狸殖吸虫引起的主要病变是血等，称肺吸虫病斯氏狸殖吸虫引起的主要病变是游走性皮下包块和渗出性胸膜炎游走性皮下包块和渗出性胸膜炎Ø自然疫源性疾病自然疫源性疾病病原学病原学Ø病原体：卫氏并殖吸虫和斯氏并殖吸虫病原体：卫氏并殖吸虫和斯氏并殖吸虫ü卫氏并殖吸虫卫氏并殖吸虫：三倍体型虫体能在体内成熟并：三倍体型虫体能在体内成熟并产卵，二倍体型不适宜于人体寄生产卵，二倍体型不适宜于人体寄生ü斯氏并殖吸虫：虫体狭长，在人体不能发育为斯氏并殖吸虫：虫体狭长，在人体不能发育为成虫。

终宿主为犬、猫、果子狸等成虫终宿主为犬、猫、果子狸等病原学病原学Ø生活史生活史：：Ø虫卵随粪便或痰入水Ø25-30°C，21天孵出毛蚴Ø第一中间宿主第一中间宿主：淡水螺无性生殖发育，3个月左右，尾蚴逸出20 °C水中存活1-2天Ø第二中间宿主：第二中间宿主：甲壳动物（溪蟹、喇蛄），形成囊蚴，囊蚴囊蚴是并殖吸虫的感染型是并殖吸虫的感染型Ø人吞食含有并殖吸虫活囊蚴的溪蟹或喇蛄而感染Ø幼虫在小肠内逸出，侵入组织，在体内游走，虫体窜行游走和贯穿组织能力强，主要寄生于肺组织（卫氏）Ø囊蚴感染制成虫发育成熟需2-3个月寿命6-20年流行病学流行病学Ø传染源：传染源：病人是卫氏病殖吸虫的重要传染源通过痰或粪便排出虫卵某些家畜和野兽是并殖吸虫的保虫宿主和传染源病人不是斯氏并殖吸虫的主要传染源犬、猫、果子狸等为其保虫宿主和传染源Ø传播途径：传播途径：生食或半生食含有囊蚴的溪蟹、喇蛄或进食含有童虫的野猪肉或生饮溪水而感染Ø易感人群：易感人群：普遍易感Ø流行特征：流行特征：分布广泛东北地区为喇蛄型卫氏并殖吸虫流行区发病机理发病机理Ø童虫引起的病变：童虫引起的病变：后尾蚴和童虫在肠道和腹腔及胸腔内窜行游走引起窦道和炎症渗出。

斯氏并殖吸虫可引起寄生部位嗜酸性肉芽肿，形成游走性皮下包块，渗出性胸膜炎和肝损害较重Ø成虫引起的病变：成虫引起的病变：可固定于某一部位，也可游走窜行形成多房性脓肿、囊肿、结节与瘢痕Ø虫卵引起的病变：虫卵引起的病变：组织反应轻微病理解剖病理解剖Ø基本病理改变：Ø脓肿期：脓肿期：单核细胞、嗜酸性粒细胞和中性粒细胞浸润Ø囊肿期：囊肿期：肉芽组织形成，围以纤维囊壁，囊内有棕褐色囊液Ø纤维瘢痕期：纤维瘢痕期：肉芽组织和纤维组织增生临床表现临床表现Ø潜伏期3-6个月临床表现复杂，起病缓慢Ø急性并殖吸虫病；Ø慢性并殖吸虫病：Ø卫氏并殖吸虫和斯氏并殖吸虫的临床表现不同卫氏并殖吸虫和斯氏并殖吸虫的临床表现不同见表见表全身症状：发热（低热）、头痛、胸闷，全身症状：发热（低热）、头痛、胸闷，过敏症状（荨麻疹、哮喘）斯氏并殖吸虫多过敏症状（荨麻疹、哮喘）斯氏并殖吸虫多见见临床表现临床表现Ø临床分型：临床分型：Ø胸肺型：咳嗽、咳痰、咯血、胸痛、气短铁铁锈色或棕褐色烂桃样血痰为最典型症状锈色或棕褐色烂桃样血痰为最典型症状为肺部坏死组织，痰中可查到虫卵）有单侧或双侧胸腔积液 卫氏并殖吸虫病卫氏并殖吸虫病 斯氏并殖吸虫病斯氏并殖吸虫病全身症状全身症状 不常见不常见 常见常见荨麻疹荨麻疹 不常见不常见 很常见很常见咳嗽咳嗽 明显，伴中等或大量痰液明显，伴中等或大量痰液 轻咳，痰量很少轻咳，痰量很少咳痰咳痰 铁锈色痰，棕褐色痰或烂桃肉样铁锈色痰，棕褐色痰或烂桃肉样 血丝痰血丝痰胸膜炎、胸腔积液胸膜炎、胸腔积液 较少见较少见 常见常见肺部损害肺部损害 常见常见 少见少见肝损害肝损害 较少见较少见 较常见较常见皮下结节与包块皮下结节与包块 10-20%病人可见，结节内查见病人可见，结节内查见 30-70%病人可见，有游走病人可见，有游走 虫卵或成虫虫卵或成虫 性包块，包块内偶见幼虫，性包块，包块内偶见幼虫， 未见成虫或虫卵未见成虫或虫卵卫氏并殖吸虫病与斯氏并殖吸虫病的鉴别表卫氏并殖吸虫病与斯氏并殖吸虫病的鉴别表临床表现临床表现Ø腹型：腹型：腹痛（阵发性或下腹隐痛）、腹泻、恶心、呕吐、肝肿大和肝功能异常。

脓肿破溃可排棕褐色粘稠血便斯氏并殖吸虫可引起肝功能异常Ø脑脊髓型：脑脊髓型：2-5%，卫氏并殖吸虫多见Ø脑型：脑型：儿童和青壮年严重感染者Ø颅内压增高症状：多见于早期Ø脑组织破坏症状：后期出现Ø刺激性症状：癫痫发作Ø炎症性症状：多见于早期Ø脊髓型：脊髓型：运动障碍、感觉缺失、坐骨神经痛、大小便失禁临床表现临床表现Ø皮肤型：皮下结节或包块Ø阴囊肿块型：Ø亚临床型：疫区多见隐性感染实验室检查实验室检查Ø一般检查一般检查:Ø血象血象：白细胞总数增高，急性期嗜酸粒细胞可达80%以上Ø脑脊液、胸腹水脑脊液、胸腹水：嗜酸粒细胞增高Ø血沉：血沉：增快Ø病原检查：病原检查：Ø痰查虫卵，粪便查虫卵Ø体液：查虫卵，嗜酸细胞增多，夏科雷登结晶Ø皮下结节和包块活检实验室检查实验室检查Ø免疫学检查免疫学检查：Ø皮内试验：1：2000成虫抗原接种前臂皮内筛查Ø酶联免疫吸附试验：与病人虫卵阳性符合率达100%滴度> 1：800可以确诊考核疗效Ø快速斑点酶联免疫吸附试验或单克隆抗体蛋白印记（western blot)：早期诊断Ø后尾蚴膜反应、间接血凝试验、间接荧光抗体试验、RIA、ABC-ELISA等ØX线检查：线检查：早期。

肺部炎性浸润，囊肿及胸腔积液ØCT诊断诊断Ø流行病学资料：流行病学资料：Ø临床资料：临床资料：Ø实验室检查实验室检查：痰、粪便或体液中查到虫卵，皮下结节活检发现虫卵、童虫、或成虫可以确诊免疫学检查有诊断意义鉴别诊断鉴别诊断Ø肺结核、肺癌肺结核、肺癌脑部寄生虫病和脑肿瘤脑部寄生虫病和脑肿瘤病毒性肝炎、肝脓肿病毒性肝炎、肝脓肿预后预后Ø一般预后较好，脑脊髓型疗效较差斯氏狸殖吸虫预后较好治疗治疗Ø病原治疗：病原治疗：Ø吡喹酮：治疗首选,25mg/kg,每日3次，连服2-3天Ø阿苯达唑：对斯氏并殖吸虫效果较好Ø硫氯酚（别丁）：用于流行区犬或猪的治疗Ø对症治疗：对症治疗：Ø镇咳、镇痛、止血；镇静、脱水；针刺、理疗等脑脊髓型内科治疗无效可外科手术预防预防Ø控制传染源控制传染源：彻底治疗病人和病畜Ø切断传播途径切断传播途径：防止粪便入水；消灭淡水螺Ø保护易感人群保护易感人群：良好的饮食习惯EEEEEEEDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuttttttttttttttttttttttttttttttttttttsssssssssssssssssssssssssssssssssssrrrrrrrrrrrrrrrrrrrrrrrrrrrrruuuuuuuuuuuuuuttttttttttttttttttttttttttttttttttttsssssssssssssssssssssssssssssssssssrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrqppppppppppppppppppppppppppppppppppppooooooooooooooooooooooooooooooooooonnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmllllllllllllllllllllllllllllllllllllkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiihhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhgggggggggggggggggggggggggggggggggggffffffffffffffffffffffffffffffffffffeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeddddddddddddddddddddddddddddddddddddcccccccccccccccccccccccccccccccccccbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa9999999999999999999999999999999999988888888888888888888888888888888888877777777777777777777777777777777777666666666666666666666666666666666666555555555555555555555555555555588888888888877777777777777777777777777777777777766666666666666666666666666666666666555555555555555555555555555555555555444444444444444444444444444444444443333333333333333333333333333333333322222222222222222222222222222222222211111111111111111111111111111111111000000000000000000000000000000000000+++++++++++++++++++++++++++++++++++------------------------------------)))))))))))))))))))))))))))))))))))((((((((((((((((((((((((((((((((((((***********************************&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!&&&&&&&&%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!####################################ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSRRVVVVVUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOONNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFEIIIIIIIHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxwwwwwwwwwwwwwwwwwwwwwwwwwwwwzzzzzzzzzzzzzzzyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuutttttttttttttttttttttttttttttttttttssssssssssssssssssssssssssssssssssssrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrpppppppppppppppppppppppppppppppppppoooooooooooooooooooooooooooooooooooonnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmllllllllllllllllllllllllllllllllllllkkkkkkkkkkkkkkkkkkkkkkkknnnnnnnnnnnnnnnnnnnmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmlllllllllllllllllllllllllllllllllllkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiihhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhgggkkkkkjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiihhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhggggggggggggggggggggggggggggggggggggfffffffffffffffffffffffffffffffffffeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeedddddddddddddddddddddddddddddddddddccccccccccccccccccccccccccccccccccccbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa99999999999999999999999999999999999988888888888888888888888888888888888777777777aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa99999999999999999999999999999999999888888888888888888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