肝肺吸蟲課件

NemotodaCestodaTrematodaMedicalhelminth.NemotodaMedicalhelminth.1LiverFluke.VocabularyDioecism[dai‘i:siz?m]雌雄異體Hermaphroditic[h?:m?fr?‘ditik]雌雄同體Miracidium[‘mair?‘sidi?m]毛蚴Sporocyst[‘sp?:r?‘sist]胞蚴Encytedmetacercaria[‘met?s?:’k??ri?]囊蚴Rediae雷蚴Cercariae尾蚴Encyst-excyst成囊-脫囊.LiverFluke.VocabularyDioecism2LiverFluke.VocabularyBile膽汁Clonorchiasis[’kl?un?:’kai?sis]

肝吸蟲病Intrahepaticbileduct肝膽管Pancreatic胰腺的Gallbladder膽囊Faeces[’fi:si:z]糞便Diarrhoea[’da??’r??]腹瀉putrescent[pju:’tresnt]

壞死.LiverFluke.VocabularyBile膽汁3LiverFluke.VocabularyHepatocirrhosis

[’hep?t?usi’r?usis]肝硬化Atrophy[’?tr?fi]萎縮ascites[?’saiti:z]腹水.LiverFluke.VocabularyHepatoci4

Trematodes,FlukesGeneralcharacters.Trematodes,FlukesGeneralcha5

MophologyGeneralcharacters

Leave-shaped,flatHermaphroditic(exceptSchistosome)havemouthbutnoanusWithoralsuckerandventralsuckerMostfluke’segghasaoperculum.MophologyGeneralcharacters6Adultworms

eggscercariaRediaeSporocystMiracidia

encystedmetacercariaLifecycleDefinitivehostSecondintermediatehostFirstintermediatehostGeneralcharacters

Mophology.AdultwormscercariaRediaeSpor7metagenesisasexualgenerationSexualgenerationGeneralcharacters

MophologyLifecycle.metagenesisasexualgenerationS8Morethan30speciesofflukesparasiticinhumanbody,allbelongtoPhylumPlatyminthes(扁形動(dòng)物門）

ClassTrematoda（吸蟲綱）

OrderDigenea（復(fù)殖目）Generalcharacters

speciesofflukes.Morethan30speciesoffluke9Flukesendemicinchina

Clonorchissinensis華支睪吸蟲

Paragonimuswestermani

衛(wèi)氏并殖吸蟲

Schistosomajaponicum

日本血吸蟲

Fasciolopsisbuski

布氏姜片吸蟲

Pagumogonimusskrjabini

斯氏貍殖吸蟲Generalcharacters

speciesofflukes.FlukesendemicinchinaClono10華支睪吸蟲(Clonorchissinensis)introduction肝吸蟲(liverfluke）causingClonorchiasisFirstlyfoundinaIndianChinese’sbileductin1874..華支睪吸蟲(Clonorchissinensis)intr11

MorphologyLifecyclePathogenesisDiagnosisPrevalenceProphylaxis肝吸蟲(liverfluke）華支睪吸蟲(Clonorchissinensis).Morphology肝吸蟲(liverfluke）華支睪12LiverflukeMorphology10-25×3-5mmOralsuckerVentralsuckerSpermary睪丸Uterus子宮Intestinebranch1.AdultwormGullet咽Overy卵巢.LiverflukeMorphology10-25×3-131.AdultwormLiverflukemorphology.1.AdultwormLiverflukemorpho14Sesamelike,broadlyovoidLightyellowish-brown2.egg29×17um，sizecolorshapeshellContainingWithadistinctconvexoperculumamiracidiuminsidetheeggLiverflukemorphology.Sesamelike,broadlyovoidLigh152.egg卵蓋operculum肩峰shoulder卵殼shell毛蚴miracidium疣狀突起tinyknobLiverflukemorphologysizecolorshapeshellContaining.2.egg卵蓋operculum肩峰shoulder卵殼s16蠕蟲卵中我最小，形似芝麻棕黃色。上有蓋來下有疣，肩峰明顯內(nèi)毛蚴。2.eggLiverflukemorphology.蠕蟲卵中我最小，2.eggLiverflukemorph17MiracidiumLiverflukemorphology3.Otherstage.MiracidiumLiverflukemorpholo18Liverflukemorphologyotherstages

sporocyst3.Otherstage.Liverflukemorphologyothers19rediaeLiverflukemorphologyotherstages

GenerationcellUnmatureCercariae3.Otherstage.rediaeLiverflukemorphologyo20CercariaeLiverflukemorphologyotherstages

3.Otherstage.CercariaeLiverflukemorpholog21Liverflukemorphologyotherstages

FreshwaterfishEncystedmetacercariaeinfishmusculature3.Otherstage.Liverflukemorphologyothers22Liverflukelifecycle

FirstintermidiatehostSecondintermidiatehostDefinitivehostshrimpCyprinidaesnail.LiverflukelifecycleFirst23Liverflukelifecycle

Adult

wormseggmiracidiumSporacyst

rediaecercariaeEncyctedmtacercariae.LiverflukelifecycleAdult24尾蚴雷蚴胞蚴毛蚴囊蚴貓25-30d鼠21d100d25℃時(shí)，30-40d童蟲成蟲卵Liverflukelifecycle

.尾蚴雷蚴胞蚴毛蚴囊蚴貓25-30d100d25℃時(shí)，30-251.host紋沼螺長角涵螺赤豆螺(1)thefirstintermediatehost—freshwatersnailLiverflukelifecycle

.1.host紋沼螺(1)thefirstint261.host(1)thefirstintermediatehost—freshwatersnail(2)thesecondintermediatehost—

freshwaterfish(familyCyprinidae鯉科)Liverflukelifecycleconclusion

.1.host(1)thefirstintermedia27(3)Definitivehost—human，cat,dog,pig,rat,etal.

1.Host(1)thefirstintermediatehost—

freshwatersnail(2)thesecondintermediatehost—

freshwaterfish(familyCyprinidae)Liverflukelifecycleconclusion

.(3)Definitivehost1.Host(1281.Host2.Infectionstageandmethodinfectionstage----encystedmetacercariaeinfectionway----ingestionofraw,undercooked,pickledfishharbouringmetacercariaeLiverflukelifecycleconclusion

.1.Hostinfectionstage----ency291.Host2.Infectionstageandmethod3.ExcretewayinhumanbodyInmaturewormcommonbileductbloodstreamabdomenantrum

BilepassagesLiverflukelifecycleconclusion

through.1.HostInmaturecommonbiledu301.Host2.Infectionstageandmethod3.Excretewayinhumanbody4.Parasiting

position

AdultwormsareparasiticinbileductsLiverflukelifecycleconclusion

.1.HostAdultwormsareLiverf311.host2.infectionstageandmethod3.passingwayinhumanbody4.parasitizedposition5.leavingbodystageandmethod

eggsexitthebileductandareexcretedinthefaecesLiverflukelifecycleconclusion

.1.hosteggsexitthebiledu32PathogeneticstagePathogeneticmechenismSymptomologyLiverflukepathogenicity

.PathogeneticstageLiverfluke33ImmatureadultwormMatureadultwormEggsLiverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.ImmatureadultwormLiverfluke34metablitesandmechanicaleffectscausesproliferativeandinflammatoryreactionsinthebiliaryepitheliumofthebileducts.Encapsulating

fibrosisoftheductsBile

ductsaredilatedatthepointswheretheflukesareattachedtotheinnerliningpathogeneticstagePathogeneticmechanismSymptomologyLiverflukepathogenicity

.metablitesandmechanicaleff35②chronicinfection,hepaticcellsnearthebilepassagesbecomedenaturalizedand

putrescent(壞死)，causinghepatictissueatrophy(萎縮)apparently.③lateperiod,causinghepatocirrhosis(肝硬化)andascites(腹水).①ifparasitizedbylargeamountofflukes,bileductwillbeobstructed,bileisblockedandicteruswillhappen.Liverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.②chronicinfection,hepaticce36OtherdiseasescausedCholecystitis(膽囊炎)，cholangitis(膽管炎)，hepatitis(肝炎)；cholelithiasis(膽石癥)pancreaticinflammatory(胰腺炎)cholangiocarcinoma(膽管上皮癌)hepatiticcancer肝癌；hypogenesis(發(fā)育不良)Liverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.OtherdiseasescausedLiverfl37頭痛乏力，消化不良；腹痛腹瀉，上腹不適；肝區(qū)隱痛，常不明顯。頭乏消肝痛，三腹并不適Liverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomologyHeadache,beingtiredanddyspepsia,abdominaldistress,diarrhoea,midsectionbeingdiscomfortable,andwithminorsymptomofacheinliver..頭痛乏力，消化不良；頭乏消肝痛，三腹并不適Liverfl38withasymptomoftumefactionintheliverandspleenLiverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.withasymptomoftumefaction391.diagnosisofpathogenyoffecesby（steakfecesonaslide,concentrationofeggs）ofaspiratedbilebyduodenalaspiration

膽汁（十二指腸引流）LiverflukediagnosisdemonstrationofEggsbymicroscopicalexamination.1.diagnosisofpathogenyof402.immunodiagnosis（forscreeningpatientsprimarily,andassistanceofdiagnosis）skintestusingextractsofadultliverfluke皮試indirecthaemagglutinationassay(IHA)ELISALiverflukediagnosisDemonstrationofantibodiesagainstliverfluke.2.immunodiagnosis（forscreenin411.distributionallovertheworld,especiallyinChina,Japan,Korea,Vietnam,andSouthestAsia我國：內(nèi).寧.西.海.新尚無內(nèi)蒙、寧夏、西藏青海、新疆高發(fā)區(qū)：珠江三角洲Liverflukeprevalence.1.distributionalloverthewo421.ditribution2.elementsrelevanttoprevalenceIntermidiatedhostThechanceofswallowingtheencystedmetacercariaeThesouceofinfectionEggsenterwaterLiverflukeprevalence.1.ditribution2.elementsreleva431997年廣東省不同魚種肝吸蟲的感染率（%）麥穗魚61.22白鰱56.3白鯇55.6花鰱54.6Liverflukeprevalence.1997年廣東省不同魚種肝吸蟲的感染率（%）Liverfl44IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeThesouceofinfectionEggsenterwaterLiverflukeprophylaxis.IntermidiatedThechanceofsw45IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeThesouceofinfectionEggsenterwaterLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson.IntermidiatedThechanceofsw46IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeEggsenterwaterLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson.IntermidiatedThechanceofsw47IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeEggsenterwaterLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces..IntermidiatedThechanceofsw48IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces..IntermidiatedThechanceofsw49IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces.3.Changethehabitofeating(uncookedfish)；.IntermidiatedThechanceofsw50IntermidiatedhostLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces.3.Changethehabitofeating(uncookedfish)；.IntermidiatedLiverflukepr51并殖吸蟲（Paragonimus)第三節(jié).肺吸蟲（lungflukes)概述衛(wèi)氏并殖吸蟲（肺型）斯氏貍殖吸蟲（皮膚型）.并殖吸蟲（Paragonimus)第三節(jié).肺吸蟲（lung52并殖吸蟲（Paragonimus)（一）肺吸蟲（lungflukes)衛(wèi)氏并殖吸蟲.并殖吸蟲（Paragonimus)（一）肺吸蟲（lungf53肺吸蟲形態(tài)

1.成蟲

長7-12mm寬4-6mm厚3.5-5.肺吸蟲形態(tài)1.成蟲長7-12mm.54肺吸蟲形態(tài)

1.成蟲體棘游走習(xí)性.肺吸蟲形態(tài)1.成蟲體棘游走習(xí)性.55肺吸蟲形態(tài)

2.蟲卵大小顏色形狀結(jié)構(gòu)56100um.肺吸蟲形態(tài)2.蟲卵大小顏色形狀結(jié)構(gòu)56100um56肺吸蟲形態(tài)

2.蟲卵卵殼卵黃細(xì)胞卵細(xì)胞卵蓋56100um大小顏色形狀結(jié)構(gòu).肺吸蟲形態(tài)2.蟲卵卵殼卵黃細(xì)胞卵細(xì)胞卵蓋56100um57肺吸蟲形態(tài)

3.其他雷蚴囊蚴尾蚴.肺吸蟲形態(tài)3.其他雷蚴囊蚴尾蚴.58肺吸蟲生活史

.肺吸蟲生活史.59尾蚴母雷蚴子雷蚴胞蚴毛蚴童蟲成蟲卵囊蚴肺吸蟲生活史

.尾蚴母雷蚴胞蚴毛蚴童蟲囊蚴肺吸蟲生活史.601.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式①第一中間宿主—川卷螺肺吸蟲生活史

.1.宿主①第一中間宿主—川卷螺肺吸蟲生活史.611.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式①第一中間宿主—川卷螺②第二中間宿主—溪蟹、蝲蛄肺吸蟲生活史

.1.宿主①第一中間宿主—川卷螺②第二中間宿主—溪蟹621.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式③終宿主—人，肉食性的哺乳動(dòng)物

（保蟲宿主）①第一中間宿主—川卷螺②第二中間宿主—溪蟹、蝲蛄肺吸蟲生活史

.1.宿主③終宿主—人，肉食性的哺乳動(dòng)物①第一中間宿主631.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式感染階段：囊蚴感染方式：生食/半生食溪蟹、蝲蛄

肺吸蟲生活史

.1.宿主感染階段：囊蚴肺吸蟲生活史.641.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式肺吸蟲生活史

皮下腸壁腹腔膈肌胸腔肺童蟲腹壁縱隔心、腦.1.宿主肺吸蟲生活史皮下腸壁腹腔膈肌胸腔肺童蟲腹壁縱隔心651.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式肺吸蟲生活史

蟲囊.1.宿主肺吸蟲生活史蟲囊.661.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式肺吸蟲生活史

蟲卵去向：蟲囊完整時(shí)，蟲卵沉積于囊內(nèi)；蟲囊與血管相通：引起小血管栓塞；蟲囊與淋巴管相通：蟲卵沉積于肺淋巴結(jié)；

蟲囊與支氣管相通：蟲卵隨痰/糞排出體外。.1.宿主肺吸蟲生活史蟲卵去向67肺吸蟲致病

致病階段致病機(jī)理臨床表現(xiàn).肺吸蟲致病致病階段.68肺吸蟲致病

致病階段致病機(jī)理臨床表現(xiàn)童蟲、成蟲.肺吸蟲致病致病階段童蟲、成蟲.69肺吸蟲致病

致病階段致病機(jī)理臨床表現(xiàn)童蟲/成蟲的機(jī)械性損傷及異物反應(yīng)。膿腫期囊腫期纖維斑痕期肺型肺吸蟲病：.肺吸蟲致病致病階段童蟲/成蟲的機(jī)械性損傷及異物反應(yīng)。膿70肺吸蟲致病

致病階段致病機(jī)理臨床表現(xiàn)童蟲/成蟲的機(jī)械性損傷及異物反應(yīng)。膿腫期囊腫期纖維斑痕期細(xì)胞浸潤局部出血組織壞死肉芽組織增生并包圍蟲體，囊內(nèi)可見大量蟲卵和夏科雷登結(jié)晶蟲體轉(zhuǎn)移或死亡，形成疤痕病理變化X線特征浸潤性陰影多房性囊樣陰影硬結(jié)性或