寄生蟲醫(yī)學(xué)課件：plasmodia2015雙語(m)

1、Prof. Huanhuan Shi,Malaria Parasite,病歷摘要,男，35歲，高熱伴寒戰(zhàn)、大汗7天，意識不清2天入院，體檢發(fā)現(xiàn)貧血、脾腫大，2日后搶救無效死亡 患者半年前曾去非洲尼日利亞，尸檢發(fā)現(xiàn)血液內(nèi)大量瘧原蟲,為何該病人有寒戰(zhàn)伴高熱、大汗？ 為何該病人出現(xiàn)意識不清并最終死亡？ 為何該病人有貧血并伴隨脾腫大？,寄生于人體的瘧原蟲,間日瘧原蟲 Plasmodium vivax P.v.,惡性瘧原蟲 P. falciparum P.f.,三日瘧原蟲 P. malariae P.m.,卵形瘧原蟲 P. ovale P.o.,世界性 分布 (國內(nèi)、廣西常見）,主要分布于國外,Viva

2、x malaria,Quartan,Ovale malaria,falciparum malaria,Malaria is one of the major public health challenges eroding development in the poorest countries in the world.,Why worry about malaria?,Malaria makes the poor even poorer,Malaria costs Africa more than US$ 12 billion annually. It has slowed economi

3、c growth in African countries by 1.3% per year,Morphology,Anopheles,Human body,Morphology,In blood smears stained by Giemsas, Plasmodia cytoplasm were stained as light blue color and nuclear chromatin red color, while cytoplasm of the infected erythrocyte stains pink color.,RBC（pink）,Nuclear （red or

4、 purple）,Cytoplasm （light blue）,Pigment,Schuffners dots,Erythrocytic stages of P.v,Ring form,Large trophozoite,immature schizont,mature schizont,microgametocyte,macrogametocyte,Erythrocytic cycle,merozoite,Erythrocytic stage,Ring form 環(huán)狀體,Amoeboid,Trophozoite 大滋養(yǎng)體,Erythrocytic stage,Immature Schizon

5、t 未成熟裂殖體,mature schizont 成熟裂殖體,Erythrocytic stage,Formation of gametocyte,Microgametocyte 雄配子體,Macrogametocyte 雌配子體,Formation of gametocyte,Ring form,Erythrocytic stages of P.f,macrogametocyte,microgametocyte,Large trophozoite and schizont of P.f. are seldom seen in peripheral blood.,Ring form,gamet

6、ocyte,Comparison between P.v and P.f,Ring form,Large trophozoit,schizont,gametocyte,P.v,P.f,Seldom seen in peripheral blood,Life cycle,Anopheles,Human body,子孢子,速發(fā)型,遲發(fā)型,紅外期 8 d,6-12M,裂殖體,裂殖子,環(huán)狀體,大滋養(yǎng)體,裂殖體,裂殖子,巨噬細(xì)胞吞噬,侵入 紅細(xì)胞,雌配子體,雄配子體,人體內(nèi),按蚊體內(nèi),雄配子,雌配子,合子,動合子,囊合子,子孢子,紅內(nèi)期 （48h）,配子生殖期,孢子增殖期,肝細(xì)胞內(nèi),紅細(xì)胞內(nèi),P.m.7

7、2h P.f. 48h, P.o 48h,間日瘧原蟲生活史,1、無遲發(fā)型子孢子，故無復(fù)發(fā)；,2、紅外期發(fā)育時(shí)間：6天；,3、大滋養(yǎng)體和裂殖體在內(nèi)臟與皮下脂肪毛細(xì)血管內(nèi)寄生，在外周血中不易查見。 4、外周血現(xiàn)瘧7-10天才出現(xiàn)配子體。,P.f. 與P.v.的生活史比較， 主要不同點(diǎn),生活史學(xué)習(xí)要點(diǎn)： 1.感染階段：子孢子；紅內(nèi)期瘧原蟲 2.感染途徑與方式：蚊蟲叮咬;輸血或經(jīng)胎盤。 3.致病階段：紅內(nèi)期瘧原蟲 4.寄生部位：肝細(xì)胞、紅細(xì)胞 5.媒介：雌性按蚊(為終宿主） 6.診斷階段：紅內(nèi)期原蟲,Pathogensis & manifestation,子孢子侵入,初發(fā),再燃,復(fù)發(fā),潛伏期,隱匿期,

8、隱匿期,6-12個(gè)月（P.V遲發(fā)型）,速發(fā)型,The Process of malarial infection,Include: incubation period, first paroxysm, recrudescence and relaps.,Incubation period 潛伏期,The incubation period represents the interval between the bite of infecting mosquito and onset of clinical symptoms. It is the duration of preerythrocy

9、tic period and the time of erythrocytic parasities multiplying sufficiently to the liminal value that is able to produce clinical symptoms.,Incubation: P.v.-transmitted by mosquito : around 14 d. transmitted by blood transfussion : around7 d long incubation: 6m-12m. P.f.-transmitted by mosquito : ar

10、ound 11d.,Malarial paroxysm,Fever with tertian periodicity in vivax malaria,Blood stage parasites are responsible for the clinical manifestations of the disease.,Symptoms of malaria typically consist of definite paroxysms of chills, fever and sweating.,瘧疾發(fā)作,Higher sympathetic excitability,Merozoites

11、, metabolites of malaria parasite , denatured hemoglobin and fragment infected RBC,stimulate,Nerve center that controls temperature,Mechanism of paroxysm,Fever,Exogenous or endogenous pyrogen,Typical manifestation,Chill 寒戰(zhàn),High fever 高熱,Sweating 出汗退熱,30 - 60min,3- 4 h,2-3h,Fever with tertian periodi

12、city in vivax malaria 隔天發(fā)作，呈周期性,寒戰(zhàn) 高熱,出汗 退熱,間日瘧 隔一日發(fā)作一次,三日瘧 隔兩日發(fā)作一次,裂體增殖周期,瘧疾發(fā)作周期,=,A victim of Highland Malaria at TransMara Medical Center,A young girl with Highland Malaria waiting for medicine at Shankoe,Malaria patients,Recrudescence 再燃,Recrudescence is the recurrence of symptoms after a tempor

13、ary abatement(some days or weeks). P. falciparum is the usual cause of recrudescent infections and these arise 2-4 weeks following treatment. Reasonmalaria parasites remained in RBC multiply again.,Relapse is the return of a disease after its apparent cessation. Both P. vivax and P. ovale have a ten

14、dency to relapse after resolution of the primary infection. Relapses occur weeks or months after the primary infection. Reasonbradysporozoites stayed in hepatic cell multiply.,Relapse 復(fù)發(fā),Cerebral malaria (CM)腦型瘧 -Severe Falciparum Malaria CM, life-threatening malaria is nearly always caused by P. fa

15、lciparum. The symptoms are very serious, such as Lasting high temperature (40-41C), unconsciousness and shock. High mortality Overall mortality in treated cerebral malaria in reported studies averages 15% in children and 20% in adults (but up to 50% in pregnancy),My head hurts so much,1.Anemia REASO

16、N * Destruction of erythrocytes parasitized * Enhancement of spleen function * Depression of marrow function * Immunopathological mechanisms,complications,2. Hepatosplenomegalia,Enlarged liver and spleen (below navel),Hyperplasia of reticuloendothelial system,Reason:,3. Malaria nephritis 瘧疾腎病 多見于P.m

17、 感染的慢性病人 4. Fever with dark urine 黑尿熱 常見于G6PD缺乏者服用伯喹等藥物引起,Laboratory diagnosis,Thin or thick blood film 1 .Collection of blood: peripheral blood smears 2. Giemsa or Wrights staining 3. Examination under microscopy,Laboratory diagnosis,Taking finger(or ear lobe) prick blood for malaria test,A doctor

18、takes a blood smear from a baby,Laboratory diagnosis,A hospital worker examining a blood smear,Immunodiagnosis 1)Detection of an antigen 2)Detection of antibodies Molecular diagnosis Polymerase-chain rection (PCR),Laboratory diagnosis,Molecular Diagnosis,Lane S: molecular base pair standard (50-bp l

19、adder). Black arrows show the size of standard bands. Lane 1: P. vivax (size: 120 bp) Lane 2: the red arrow shows the P. malariae (size: 144 bp) Lane 3: P. falciparum (size: 205 bp) Lane 4: P. ovale (size: 800 bp),Laboratory diagnosis,Epidemiology & control,Distribution Malaria is probably the most

20、widespread of all diseases. P. vivax is widespread in the tropics and sub-tropics, and in some temperate regions. P. falciparum is found most commonly in warm moist climates. P. malariae occurs throughout the tropics. P. ovale is uncommon.,Epidemiology,Geographic Distribution,根據(jù)世界衛(wèi)生組織發(fā)布數(shù)據(jù)，全球86的瘧疾病例發(fā)

21、生在非洲，9的病例發(fā)生在東南亞，其余5的病例分布在全球其它地區(qū)。,（2）國內(nèi)瘧疾流行區(qū)（2013）,2013年全國報(bào)道3000例，流行區(qū)范圍大幅度縮小，除云南、海南兩省外，其他省份已消除惡性瘧。但是，近年來，由于外出務(wù)工、經(jīng)商、旅游等人口流動頻繁，輸入性瘧疾病例呈上升趨勢。比較典型案例的是2013年廣西上林縣加納務(wù)工返鄉(xiāng)人員事件。2012年發(fā)現(xiàn)127例，而2013年6月,由于大批在非洲加納務(wù)工人大集中返鄉(xiāng),上林縣輸入性瘧疾病例出現(xiàn)大幅上升。上林縣衛(wèi)生部門共對2079名疫區(qū)返鄉(xiāng)人員進(jìn)行了血檢,報(bào)告病例389例,所有瘧疾病例均為輸入性病例。 我國瘧疾主要流行于云南、海南、貴州等南部地區(qū)和安徽、河南

22、、江蘇、湖北等中部地區(qū)。,Source of infection.,The patients or carriers whose blood contains mature gametocytes.,Mosquito vectors,Anopheline mosquitoes are the vectors of malaria,In China: A. sinensis 中華按蚊 minimus 微小按蚊 A. anthropophage 嗜人按蚊 A. dirus 大劣按蚊,Epidemiology,Susceptible persons,Epidemiologic factors,The epidemiology of malaria is influenced by the climate, topography, socio-economic status o