寄生蟲匯總表格6頁.doc

Speciesinfective stageinfective routeSite of inhabitationIntermediate hostReservoir host Harms to manDiagnostic methodDrug of choiceAscaris LumbricoidesEmbryonate eggsBy mouthUpper part of small intestinenonoLoefflers syndromeBiliary ascariasisDirect fecal filmBrine-floatation methodAlbendazole 400mg/d 1-2dMebendazole 100mg/d 3-4dPiperazine IvermectinTrichuris trichiura (whip worm)Embryonate eggsBy mouthileocecumnonoMiddle infectionHeavy infectionBrine-floatation methodDirect fecal filmAlbendazole 400mg/d 1-2dMebendazole 100mg/d 3-4d(prolonged for 5 days)Enterobius vermicularisEmbryonate eggsBy mouth or retro-infectionileocecumnonoChildren Ectopic injureCellophane tape methodAlbendazole Mebendazole(repeated treatment)HookwormsLarva 3 or filariform larvaBy skinUpper part of small intestinenonoDermatitis pneumonitis Microcytic hypochromatic anemia AllotriophagyHemoglobin lower 12m,11FSaturated brine floatationAlbendazole Mebendazole Avoid skin contactFilariaefilariform larva(L3)By skinLymphatic tissuesmosquitoesnoFilarialfever, retro-lymphangitis, lymphadenitis Elephantiasis Chyluria HydroceleThick blood smear Millipore membrane filtration Diethylcarbamazine(DEC, Hetrazan) DEC table salt, IvermectinTrichinella spiralisJuvenile in the cystEating raw meatAdults in small intestine, juvenile in skeletal musclemammalsmammal1 Invading StageIntestinal bleeding, etc.2 Larva migrating stageVessels, skeletal cell 3 Encysted stageAcute symptoms subside, muscular pain continuesMuscular biopsy, Examination and xenodiagnosis of the remainder of the raw or uncooked meatAlbendazole Mebendazole(not well), Corticosteroids in acute stageClonorchis sinensismetacercariaEating raw freshwater fish and shrimp with metacercaria Bile ducts1st Bithynia snail2nd Family of CyprinidaeCat, dogGeneral case:Severe case: In child case:1.Alkli digestive method(NaOH10%)2.water sedimentation3.direct fecal smear4.duodenal aspirationPraziquantel (吡喹酮)Hexachloroparaxylol(六氯對二甲苯)Bithionol(硫雙二氯酚;bitin)albendazoleFasciolopsis buskimetacercariaEating raw water plants with MSmall intestinePlanorbis snailpig(adhesion)abdominal discomfort and diarrheaMalnutrition1.direct fecal smear 2.water sedimentation methodPraziquantel HexachloroparaxylolBithionol(bitin)(pig) dipterex (敵百蟲)Paragonimus westermanimetacercariaEating raw fresh water crabs and crayfish with MLungs and ectopic parasitism1st melania snail2nd fresh water crab and crayfishCarnivores(tiger lion wolf etc)(Invading and migrating .Suppurative. Cystic. Fibrous-scar stage)Pulmonary Brain Abdominal Subcutaneous typeSputum:1.Alkali digestive 2.directStool: 1.Alkali 2.water 3.directBiopsy(Subcutaneous type).CT X-rayPraziquantel HexachloroparaxylolBithionol(bitin)Schistoma japonicumcercariaContact with the infective water(cercaria invade skin)Portal vein system, mainly in the inferior mesenteric veinOncomelania snail(釘螺)Herbivorous, carnivorous, and omnivorous mammal.1.Cercaria and schistosomulum2.Adults3.Eggs:(SEA) eggs inlaid in the portal areas and intestinal wall1.Stool examination(direct-acute stage; concentration method)2.Biopsy (proctoscopy)1.Praziquantel HexachloroparaxylolAntimony potassium(酒石酸銻鉀)2.dipterex(敵百蟲) for domestic animal.Taenia soliumCysticercus and eggIngesting raw bean-pork or eggAdult:human small intestineCysticercus:pig or human tissuesPig and man1.Teaniasis 2.Cysticercosis:(Subcutaneous and muscular type, Ocular type, Brain type)1.Find gravid proglottids (direct,floatation, scotch tape)2.Cysticercosis: Biopsy(S.type) Ophthalmoscope, CT,MR(B.S.M.type)1.Teaniasis:(Chinese herb Med)Areca nut(檳榔)and Pumpkin seed.-(stool scolex recognition). Praziquantel (no cysticercus) 2.Cysticercosis: surgical removal, Praziquantel(cerebral C)Echinococcus granulosus(pastoral areas)eggIngesting eggsAdult in small intestines of canine animalsMetacestode (larval stage) in tissues of herbivores or manHerbivores (sheep,goat,etc) human1.Hydatidosis(liver,lung, CNS,bone,peritoneal cavity)2.Allergic reaction3.secondary infection1.Detection of indication of hydatid cys(H.thrill)Puncture(dangerous)B ultrasonography, CT,MR,X-ray (cyst in lung and bone)1.Surgery (large and accessible unilocular hydatid) 2. Praziquantel and albendazole (early small cysts)Entamoeba histolyticaCyst with 4 nucleiBy mouthIntestine;Excystation in duodenum; Encystations in colon1.Materials: lectin, amoebic pore forming(穿孔素), protein dissolving enzyme.Flask-shaped ulcer2.Intestinal amoebiasis: A.dysentery3.Extra-intestinal(complications):A.abcess of L.P.B.1.Stool E.Living trophozoite in unformed feces(direct or NS)Cyst in formed feces(Iodine stain for chronic case or carrier)2.Immunological.T(Destroy intra or extra-intestinal pathogens)Metronidazole(甲硝唑)(acute A.dysentary)Chloroquine(氯喹) (liver A.abcess)Compatibility of the two drugs.Leishmania donovaniPromastigotes(Amastigotes is pathogenic stage)Bitten by sandflymacrophagesdogs(Visceral leishmaniasis)1.prolonged low grade F2.Hepto-splenomegaly, B.marrow hyperplasia3.Anemia,Leukopenia, Decrease in platelets4.ratio of A:G inverted5.Bleeding and infectionDemonstration of L.D body in D.smear or promastigotes in 3N medium.B.marrow punctureLymph N.puncture1.Antimony sodium gluconate葡萄糖酸銻鈉(pentavalent) (I.V or I.M)2.Pentamidine(戊烷脒) for patient resistant to the pentavalent3.Stibiihexonas(斯銻黒克)?Giardia lambliaCyst with 4 nucleiBy mouthUpper part of small intestine and bile passage(adhering and covering epithelia) diarrhea,anorexia, A.pain, weight loss, malnutrition, cholecystitis1.Iodine stain (find cyst in F feces)2.NS D.smear to detect trophozoites in diarrhea feces3.duodenal aspiration(differential Diag.)Metronidazole(patient abstain from alcohol during treatment with metronidazole)Trichomonas vaginalistrophozoiteDirect or InD contact(Sextual life, swimming pool,swimsuit, commode坐便器)Female: vagina and urethra;Male: urethra and prostate(Consume glycogen, elevate pH, T.vaginalis flourish)Trichomonas vaginitis(secreat buring, itching, vaginal discharge frothy, creamy white full of)Specimen: vaginal discharge,prostatic fluid or urine.NS direct smear(trophozoites)Metronidazole(F and M)For women: vaginal suppository(栓劑)(patient abstain from alcohol)Plasmodium (P. vivaxP. falciparumP. malariaeP. ovale)(Mosquito is final host and vector)Sporozoite (or erythrocytic stage asexual parasite) (tachy-, brady-)Mosquito bite human skin;Blood transfusion via damaged placentaLiver and red blood cellshumanParasitemia(原蟲血癥)(sudden liberation of merozoites,malarial pigment and RBC debris into blood) Chill-fever-sweatingAnemia, splenomegaly, Malignant malaria (P.f)1.Thin and thick film(Giemsas stain)2.P.f: only ring forms andgametocytes canbe found in blood.Principles: eradication of- Parasites in RBC(control of symptoms); Gametocytes to prevent transmission; Bradysporozoites to prevent relapseDrugs: chloroquine, quinine, artemisinin, artemether (anti-erythrocytic drugs) Primaquine, pyrimethamine(anti-exoerythrocytic, &gametocyte)Prevention:(chemoprophylaxis)Chloroquine, pyrimethamineToxoplasma gondii(cat is final host)Oocysts, tachyzoite cyst(bradyzoites)By mouth, skin, or placenta(most important)Obligate intracellular parasite(reticuloendothelial cells and many other nucleated cells)Human and almost all mammals1.(most asympotomatic)Hepatitis, pneumonia,Blindness, severe neurological disorders(immune system compromised individuals)2.Congenital infention:(transplacental transmit)Spontaneous abortion, stil