肺吸蟲病【精品-】

1、中國醫(yī)科大學(xué)附屬盛京醫(yī)院感染科中國醫(yī)科大學(xué)附屬盛京醫(yī)院感染科 寄生于人體內(nèi)臟器（肺部為主）或皮下組織的并殖吸寄生于人體內(nèi)臟器（肺部為主）或皮下組織的并殖吸蟲所致的一種慢性寄生蟲病蟲所致的一種慢性寄生蟲病 人吞食含有并殖吸蟲活囊蚴的溪蟹或喇蛄而感染人吞食含有并殖吸蟲活囊蚴的溪蟹或喇蛄而感染 臨床表現(xiàn)：衛(wèi)氏并殖吸蟲引起以肺部病變?yōu)橹鞯娜砼R床表現(xiàn)：衛(wèi)氏并殖吸蟲引起以肺部病變?yōu)橹鞯娜硇约膊?，主要表現(xiàn)為咳嗽、咳鐵銹色或爛桃樣痰、咯性疾病，主要表現(xiàn)為咳嗽、咳鐵銹色或爛桃樣痰、咯血等，稱肺吸蟲病。斯氏貍殖吸蟲引起的主要病變是血等，稱肺吸蟲病。斯氏貍殖吸蟲引起的主要病變是游走性皮下包塊和滲出性胸膜炎游走性

2、皮下包塊和滲出性胸膜炎 自然疫源性疾病自然疫源性疾病病原體：衛(wèi)氏并殖吸蟲和斯氏并殖吸蟲病原體：衛(wèi)氏并殖吸蟲和斯氏并殖吸蟲衛(wèi)氏并殖吸蟲衛(wèi)氏并殖吸蟲：三倍體型蟲體能在體內(nèi)成熟并：三倍體型蟲體能在體內(nèi)成熟并產(chǎn)卵，二倍體型不適宜于人體寄生產(chǎn)卵，二倍體型不適宜于人體寄生斯氏并殖吸蟲：蟲體狹長(zhǎng)，在人體不能發(fā)育為斯氏并殖吸蟲：蟲體狹長(zhǎng)，在人體不能發(fā)育為成蟲。終宿主為犬、貓、果子貍等成蟲。終宿主為犬、貓、果子貍等 生活史生活史： 蟲卵隨糞便或痰入水 25-30C，21天孵出毛蚴 第一中間宿主第一中間宿主：淡水螺。無性生殖發(fā)育，3個(gè)月左右，尾蚴逸出。20 C水中存活1-2天 第二中間宿主：第二中間宿主：甲殼動(dòng)物

3、（溪蟹、喇蛄），形成囊蚴，囊蚴囊蚴是并殖吸蟲的感染型是并殖吸蟲的感染型 人吞食含有并殖吸蟲活囊蚴的溪蟹或喇蛄而感染 幼蟲在小腸內(nèi)逸出，侵入組織，在體內(nèi)游走，蟲體竄行游走和貫穿組織能力強(qiáng)，主要寄生于肺組織（衛(wèi)氏） 囊蚴感染制成蟲發(fā)育成熟需2-3個(gè)月。壽命6-20年 傳染源：傳染源：病人是衛(wèi)氏病殖吸蟲的重要傳染源。通過痰或糞便排出蟲卵。某些家畜和野獸是并殖吸蟲的保蟲宿主和傳染源。病人不是斯氏并殖吸蟲的主要傳染源。犬、貓、果子貍等為其保蟲宿主和傳染源 傳播途徑：傳播途徑：生食或半生食含有囊蚴的溪蟹、喇蛄或進(jìn)食含有童蟲的野豬肉或生飲溪水而感染 易感人群：易感人群：普遍易感。 流行特征：流行特征：分布廣

4、泛。東北地區(qū)為喇蛄型衛(wèi)氏并殖吸蟲流行區(qū) 童蟲引起的病變：童蟲引起的病變：后尾蚴和童蟲在腸道和腹腔及胸腔內(nèi)竄行游走引起竇道和炎癥滲出。斯氏并殖吸蟲可引起寄生部位嗜酸性肉芽腫，形成游走性皮下包塊，滲出性胸膜炎和肝損害較重 成蟲引起的病變：成蟲引起的病變：可固定于某一部位，也可游走竄行。形成多房性膿腫、囊腫、結(jié)節(jié)與瘢痕 蟲卵引起的病變：蟲卵引起的病變：組織反應(yīng)輕微基本病理改變：膿腫期：膿腫期：?jiǎn)魏思?xì)胞、嗜酸性粒細(xì)胞和中性粒細(xì)胞浸潤(rùn)囊腫期：囊腫期：肉芽組織形成，圍以纖維囊壁，囊內(nèi)有棕褐色囊液纖維瘢痕期：纖維瘢痕期：肉芽組織和纖維組織增生 潛伏期3-6個(gè)月。臨床表現(xiàn)復(fù)雜，起病緩慢 急性并殖吸蟲?。?慢性

5、并殖吸蟲病：衛(wèi)氏并殖吸蟲和斯氏并殖吸蟲的臨床表現(xiàn)不同衛(wèi)氏并殖吸蟲和斯氏并殖吸蟲的臨床表現(xiàn)不同見表見表全身癥狀：發(fā)熱（低熱）、頭痛、胸悶，全身癥狀：發(fā)熱（低熱）、頭痛、胸悶，過敏癥狀（蕁麻疹、哮喘）。斯氏并殖吸蟲多過敏癥狀（蕁麻疹、哮喘）。斯氏并殖吸蟲多見見臨床分型：臨床分型：胸肺型：咳嗽、咳痰、咯血、胸痛、氣短。鐵鐵銹色或棕褐色爛桃樣血痰為最典型癥狀。銹色或棕褐色爛桃樣血痰為最典型癥狀。（為肺部壞死組織，痰中可查到蟲卵）有單側(cè)或雙側(cè)胸腔積液。 衛(wèi)氏并殖吸蟲病衛(wèi)氏并殖吸蟲病 斯氏并殖吸蟲病斯氏并殖吸蟲病全身癥狀全身癥狀 不常見不常見 常見常見蕁麻疹蕁麻疹 不常見不常見 很常見很常見咳嗽咳嗽 明顯

6、，伴中等或大量痰液明顯，伴中等或大量痰液 輕咳，痰量很少輕咳，痰量很少咳痰咳痰 鐵銹色痰，棕褐色痰或爛桃肉樣鐵銹色痰，棕褐色痰或爛桃肉樣 血絲痰血絲痰胸膜炎、胸腔積液胸膜炎、胸腔積液 較少見較少見 常見常見肺部損害肺部損害 常見常見 少見少見肝損害肝損害 較少見較少見 較常見較常見皮下結(jié)節(jié)與包塊皮下結(jié)節(jié)與包塊 10-20%病人可見，結(jié)節(jié)內(nèi)查見病人可見，結(jié)節(jié)內(nèi)查見 30-70%病人可見，有游走病人可見，有游走 蟲卵或成蟲蟲卵或成蟲 性包塊，包塊內(nèi)偶見幼蟲，性包塊，包塊內(nèi)偶見幼蟲， 未見成蟲或蟲卵未見成蟲或蟲卵 腹型：腹型：腹痛（陣發(fā)性或下腹隱痛）、腹瀉、惡心、嘔吐、肝腫大和肝功能異常。膿腫破潰可

7、排棕褐色粘稠血便。斯氏并殖吸蟲可引起肝功能異常 腦脊髓型：腦脊髓型：2-5%，衛(wèi)氏并殖吸蟲多見 腦型：腦型：兒童和青壯年嚴(yán)重感染者。 顱內(nèi)壓增高癥狀：多見于早期 腦組織破壞癥狀：后期出現(xiàn) 刺激性癥狀：癲癇發(fā)作 炎癥性癥狀：多見于早期 脊髓型：脊髓型：運(yùn)動(dòng)障礙、感覺缺失、坐骨神經(jīng)痛、大小便失禁皮膚型：皮下結(jié)節(jié)或包塊陰囊腫塊型：亞臨床型：疫區(qū)多見隱性感染 一般檢查一般檢查: 血象血象：白細(xì)胞總數(shù)增高，急性期嗜酸粒細(xì)胞可達(dá)80%以上。 腦脊液、胸腹水腦脊液、胸腹水：嗜酸粒細(xì)胞增高 血沉：血沉：增快 病原檢查：病原檢查： 痰查蟲卵，糞便查蟲卵 體液：查蟲卵，嗜酸細(xì)胞增多，夏科雷登結(jié)晶 皮下結(jié)節(jié)和包塊活

8、檢 免疫學(xué)檢查免疫學(xué)檢查： 皮內(nèi)試驗(yàn)：1：2000成蟲抗原接種前臂皮內(nèi)。篩查 酶聯(lián)免疫吸附試驗(yàn)：與病人蟲卵陽性符合率達(dá)100%。滴度 1：800可以確診。考核療效 快速斑點(diǎn)酶聯(lián)免疫吸附試驗(yàn)或單克隆抗體蛋白印記（western blot)：早期診斷 后尾蚴膜反應(yīng)、間接血凝試驗(yàn)、間接熒光抗體試驗(yàn)、RIA、ABC-ELISA等 X線檢查：線檢查：早期。肺部炎性浸潤(rùn)，囊腫及胸腔積液 CT 流行病學(xué)資料：流行病學(xué)資料： 臨床資料：臨床資料： 實(shí)驗(yàn)室檢查實(shí)驗(yàn)室檢查：痰、糞便或體液中查到蟲卵，皮下結(jié)節(jié)活檢發(fā)現(xiàn)蟲卵、童蟲、或成蟲可以確診。免疫學(xué)檢查有診斷意義肺結(jié)核、肺癌肺結(jié)核、肺癌腦部寄生蟲病和腦腫瘤腦部寄生

9、蟲病和腦腫瘤病毒性肝炎、肝膿腫病毒性肝炎、肝膿腫一般預(yù)后較好，腦脊髓型療效較差。斯氏貍殖吸蟲預(yù)后較好病原治療：病原治療：吡喹酮：治療首選,25mg/kg,每日3次，連服2-3天阿苯達(dá)唑：對(duì)斯氏并殖吸蟲效果較好硫氯酚（別?。河糜诹餍袇^(qū)犬或豬的治療對(duì)癥治療：對(duì)癥治療：鎮(zhèn)咳、鎮(zhèn)痛、止血；鎮(zhèn)靜、脫水；針刺、理療等。腦脊髓型內(nèi)科治療無效可外科手術(shù)控制傳染源控制傳染源：徹底治療病人和病畜切斷傳播途徑切斷傳播途徑：防止糞便入水；消滅淡水螺保護(hù)易感人群保護(hù)易感人群：良好的飲食習(xí)慣EEEEEEEDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDCCCCCCCCCCCCCCCCCCCCCC

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