醫(yī)學(xué)人體寄生蟲學(xué) 絳蟲二

CESTODES-II細(xì)粒棘球絳蟲

Echinococcusgranulosus

TheadultwormsofEchinococcusgranulosusliveintheintestineofcarnivoresThelarvae(hydatidcysts)parasitizeinvariousherbivoroushost,includingsheep,cattle,andhumansresultinginhydatiddisease

(hydatidosis)（包蟲病、棘球蚴?。?Adult：2～7mm；Scolex:Rostellum2rowsofhooksStrobilum(3proglottids)：1immatureproglottid1matureproglottids1gravidproglottidMorphology--Adult

3與豬、牛帶絳蟲蟲卵相似，在光鏡下難以區(qū)別。Morphology——Eggs4Morphology

--hydatidcysts(棘球蚴)5Morphology--hydatidcyst(棘球蚴)Cystwall(嚢壁)germinallayer(生發(fā)層)

hydatidfluid（棘球蚴液）protoscolex(原頭蚴)daughtercyst(子囊)1cm～40cm6Broodcapsule(生發(fā)囊)Hydatidsands(囊砂、棘球蚴砂)Cystwall:Ps:Protoscolex原頭蚴

Bc:Broodcapsule生發(fā)囊

Gl:Germinallayer生發(fā)層

Ft:Fibroustissue纖維組織

Cl:Chintinlayer角質(zhì)層7Germinallayer生發(fā)層(20-25μm)Chintinlayer角質(zhì)層(1-4mm)Fibroustissue纖維組織8122μm170μm98wks

Adult(intestineof

carnivore)

——（Egg）

ingestedby

——Oncosphere

sheep/humans

throughgut

——Hydatidcystliver/lungingestedbycarnivore(thedog)-Lifecyclegrowto0.5-1cmin3-5mon10Humanbeingsareinfectedby:Egg/gravidproglottid-contaminatedfoodsordrinksIntimatecontactwithdoghosts11space-occupyinglesionLiver,lung,peritonealcavity,spleen,kidney,bone,cerebral…allergicreactioninducedbythefluidinhydatidcyst-

PathogenesisHydatidosis12hepatomegaly(肝腫大)hepatalgia（肝區(qū)疼痛）Anorexia（厭食）dyspnea(呼吸困難)obstructivejaundice（阻塞性黃疸）1.Liverhydatidosis13MultiplehydatidcystsHugehydatidcystSurgicalScience.Vol.4

No.1(2013),ArticleID:27026,9pagesDOI:10.4236/ss.2013.4100414SurgicalScience.Vol.4

No.1(2013),ArticleID:27026,9pagesDOI:10.4236/ss.2013.41004152.Pulmonaryhydatidosis

DrycoughBloodysputumChest-painDyspnea(呼吸困難)16ARareCaseofaGiantHydatidCystPreoperativechestx-ray.12.5×13.5×10cminsize17HydatidcystinthelungTwocystssuccessfullyremovedfromapatientwithPulmonaryhydatidosis

183.Peritonealhydatidosis

AscitesUmbilicalhernia（臍疝）obstructivejaundice（阻塞性黃疸）Cholecystitis(膽囊炎)19Aperitonealhydatidosiscase204.Cerebralhydatidosis

兒童高發(fā);癥狀包括：headache,nausea,vomiting,hemiplegia(偏癱)21An11yearsoldpatientwithbrainhydatidcyst225.Osseoushydatidosis

necrosisofbone,fractureHydatiddiseaseofthetibiaHydatiddiseaseofthedistalfemur23Intravesical（膀胱內(nèi)）hydatidcyst

A43-year-oldobesewomanleftflankandpelvicpain,burningmicturition.246.RuptureofcystAllergicreaction：anaphylacticshockunconsciousnessdeathSecondaryechinococcus

hydatidosis25PhysicalexaminationAhistoryofexposuretosheepdogsinanareawhereE.granulosusisendemicX-ray，ultrasound，CT，MRIDefinitivediagnosis：discoveryofprotoscolexorhydatidcystsinurine,sputum,ascites,orbyoperation

Diagnosticpunctureisdangerous-

Diagnosis26TreatmentSurgicalremovalistheonlytherapyavailableInjectionofchemicalstokill“hydatidsand”2728AhepatichydatidosiscasefromNorthernRockyMountain29Typesofmajorhepaticresectioninhydatiddisease.SurgicalScience.Vol.4

No.1(2013),ArticleID:27026,9pagesDOI:10.4236/ss.2013.4100430

-Distributionandprevention1.Geographicdistribution:cosmopolitan,cattle-,sheep-raisingareas

31

2.Factorsofprevalence:highresistanceofeggsagainstenvironmentcloserelationshipbetweenhumananddogsaswellasdomesticanimalsanddogs3233343.preventionandcontrol:

TreatmentofdomesticdogsorandeliminationofinfectedwilddogsSterilization/administrationofcysts,daughtercysts,cystsandsetc.Healtheducation35

Echinococcusmultilocularis

Adultsusuallyinfectfox,larvalstageinhumancausesalveococcosis(泡球蚴病)/

alveolarhydatiddisease(泡型包蟲病)/multilocularhydatiddisease(多房棘球包蟲病).ThemorphologyandlifecyclearesimilartoE.granulosus

363738E．GranulosusE.multilocularis

Length2~7mm 1.2~3.7mm

Scolexsimilar

Proglottids3 4~5

Metacestode

hydatidcyst alveolarcyst I.Hsheep,cattle,humans

rat,mouse,humans

D.Hdog,wolf,…fox,dog…

39E.granulosus&E.multilocularisUnilocularhydatid(單房棘球蚴)Multilocularhydatid(多房棘球蚴)Alveolarhydatid(泡球蚴)40Aratwithalveolarhydatidcysts

41UnilocularhydatidMultilocularhydatid

SlowdevelopmentofcystRapiddevelopmentofcystCysthasthick-walledchambersCysthasthin-walledchambers

SeparatedbyfibroustissueNotseparatedbyfibroustissueCystisfluidfilled,withcystsandsCystisgelatinousfilled,nocystsands

Cystisfreeofhostmaterial

Cystiscontaminatedbyhostmaterial42ThecystismultilocularandthereisnolimitationwithhumantissuesMostalveolarcystsoccurintheliverofhostSymptomsareseriousandmimichepatocarcinomaHighermortality，nochemotherapy

-

Pathogenesis434445DistributionandpreventionApproximateglobaldistributionofE.multilocularis(asof2002).46分布地區(qū)比細(xì)粒棘球絳蟲局限，在我國(guó)分布于寧夏、新疆、青海、甘肅和四川。有兩個(gè)地理流行區(qū)：中部流行區(qū)和西部流行區(qū)。1.自然疫源地的存在2.終宿主、中間宿主廣泛3.蟲卵抵抗力較強(qiáng)4.流行區(qū)居民生產(chǎn)、生活的特殊性流行（Epidemiology）47防治原則（ControlandTreatment）1.滅狐和消滅野鼠是根除感染源的主要措施。實(shí)施中注意將動(dòng)物尸體焚燒或深埋，野狗也應(yīng)殺滅或控制，對(duì)家犬則應(yīng)定期驅(qū)蟲。2.加強(qiáng)衛(wèi)生宣傳教育，流行區(qū)應(yīng)對(duì)人群進(jìn)行普查，及時(shí)根治。3.注意個(gè)人防護(hù)，講究個(gè)人及飲食衛(wèi)生，生產(chǎn)及生活中注意防止蟲卵污染。

48491.主要靠手術(shù)，應(yīng)爭(zhēng)取早期診斷。2.藥物治療：阿苯達(dá)唑、甲苯達(dá)唑、吡喹酮等。泡球蚴病的治療:HymenolepisnanaItisasmalltapewormandparasitizesintheintestineofratsandhumanscausinghymenolepiasisnana50-Morphology

Small,5~80mmlong,1mmwidthStrobilusconsistsof100-200proglottidsScolexisspherical,bears4suckersandaretractablerostellumarmedwithsinglecircleof20-30hooksAllsegmentsarewiderthanlong5152Eggingestedby

———Oncosphere(rats,humans)intestinalvillus————

Cysticercoid

———

Adult(rats,

humans)Oncosphere(insects)

—

Cysticercoidingestedby————

Adult(rats,humans)

Internalauto-infectionintestinalvillus

Oncosphere———Cysticercoid

——

AdultViaI.HDirectinfection-Lifecycle(rats,humans)53

54-

PathogenesisandDiagnosisInlightinfections,symptomsmaybeabsentInheavyinfections(auto-infection),theremaybesufficientimpairmenttothemucosalsurfaceandcauseabdominalpain,nausea，vomiting,weightloss,nervousnessanddiarrheaDiscoveryofeggsinthestoolprovidesdefinitivediagnosis55ovalshape,40x50uminsize,shellisthin,colorlessandtransparentanoncosphereissurroundedbyamembranedelicatefilamentsarisefromtwopolesofthemembraneshelloncosphere

embryonicmembrane(filamentsarisefrompoles)56-PreventionandcontrolHumaninfectionsareassociatedchieflywiththecontaminationofcereals,grains,andotherfoodstuffsbyinfectedgrainbeetlesTreatment:praziquanteliseffective,

re-examinationofstoolfollowingtherapyisimportantOwingtotheauto-infection,itisdifficulttoeradicatethewormsfromindividualpatient57HymenolepisdiminutaItisarattapeworm,andaccidentallyparasitizesinhuman,causeshymenolepiasisdiminuta.ThemorphologyandlifecyclearesimilartoH.nana58

H．NanaH.diminutaLength5～80mm200～600mmScolexrostellumwithhooksnotobviousrostellum,nohooks

59H.nanaH.dimunita60

H．NanaH.diminuta

Length5～80mm200～600mmScolexrostellumwithhooksnotobviousrostellum,nohooksEggtransparent,thinshellyellow,thickshellwithpolarfilaments(極絲)nopolarfilaments(極絲)

61H.nanaH.dimu