蟯蟲病Causing

enterobiasis蠕形住腸線蟲

蟯

蟲Enterobius

vermicularis

pinworm2021/9/91全球分布比例我國以江蘇、福建省感染率最高人為唯一的傳染源2021/9/92成蟲Adult:♀

8

─13mm♂

2

─

5mm針狀pin-like,乳白white,三個(gè)唇瓣three

lips,頭翼cephalic

alae,咽管球a

pharyngeal

bulb.雌蟲female:雄蟲male:形態(tài)Morphology2021/9/932021/9/94蟲卵Egg:卵圓Oval,無色colorless,一端扁平flattened

on

one

side,一條蝌蚪狀幼蟲a

tadpole

stage

in

it.2021/9/9562021/9/92021/9/96AdulteggInfectivestageGravid

female

migrate

and

emerges

nocturnallyon

the

perianal

skin,

discharge

eggs,

usuallydeposits

all

her

eggs

at

once,

and

perishes

andmay

reenter

the

intestinal

canal

orfemale

vaginaIngested

by

man,

larvae

hatch

onreaching

the

cecal

region6

hours生活史Life

cycle2021/9/97三.生活史成蟲

卵

感染期蟲卵(大腸)

（肛周）

(經(jīng)口、吸入感染)幼蟲夜間肛周產(chǎn)卵壽命：<2個(gè)月

(life

span)（小腸內(nèi)蛻皮二次）2-4周（十二指腸孵出）6小時(shí)產(chǎn)卵后雌蟲3個(gè)結(jié)局2021/9/982021/9/99致病Pathogenesis1.

局部癥狀local

symptom肛門搔癢Crawling

sensation

and

anal

pruritus2.

全身癥狀general神經(jīng)系統(tǒng):

煩躁irritable,

夜驚nightmare,

失眠

insomnia消化系統(tǒng)癥狀:.2021/9/9103.

異位寄生2021/9/911?陰道炎Vaginitis,輸卵管炎salpingitis.并發(fā)癥Complications:??蟯蟲性闌尾炎appendicitis

withenterobiasis,泌尿生殖系統(tǒng)urogenital

and

pelvicinflammation診斷Diagnosis:1.

查蟲卵：肛周(around

anus)《蟯蟲病的診斷》(WS

469-2015)

中華人民共和國我國行業(yè)標(biāo)準(zhǔn)1)

透明膠紙法Cellophane

tape

impression2)

肛門棉纖拭子法Scotch

tape

swabs and

cotton

swabs注意:檢查時(shí)間checking

time部位

position2.找成蟲:肛周(夜間)Finding

of

female

worm2021/9/9122021/9/9132021/9/9142021/9/915流行Epidemiology:托兒所Kindergarten,全球感染者不少于5億人口手食物玩具口,Anus-to

mouth

by分布distribution:世界性

城市

>

農(nóng)村兒童>成人（5～7歲）傳播方式肛門經(jīng)口感染污染fingers吸入感染蟲卵輕,可暫時(shí)性懸浮空間Air-borne

eggs

,近年來下降趨勢(shì)明顯2021/9/916自身感染Auto-infection.防治Prevention

and

treatment:1.

講究衛(wèi)生Personal

and

group

hygiene個(gè)人衛(wèi)生：personal

hygiene洗手、剪指甲、不穿開襠褲……公共衛(wèi)生: communal

hygiene托兒所玩具消毒sterilization

,0.05%碘液消毒玩具浸泡1小時(shí)或太陽下曝曬(insolate)2021/9/9172021/9/9182.治療病人Treatment:有計(jì)劃、定期對(duì)集體機(jī)構(gòu)檢查和治療藥物:1)口服:阿苯達(dá)唑Albendazole,甲苯咪唑Melbendazole噻嘧啶Pyrrinium

pamoate,2)

外用:

蟯蟲膏

ointment

used2%白降汞膏(white

precipitate

ointment)龍膽紫(alkalescene

dye)止癢殺蟲2021/9/919Enterobius

vermicularis

infection

of

the

appendix

as

a

cause

of

acuteappendicitis

in

a

Greek

adolescent:a

case

reportA

15

years

old

female

(student,

48

kg

weight,

162

cm

height)presented

initially

withdiffuse

acuteabdominal

pain.Within

12

hours

of

onset,

she

noted

anorexia

withoutnausea

or

vomiting.The

patient's

abdominal

pain

typicallyincreasedin

intensity

and

the

characteristic

shift

in

thepainto

the

right

lower

quadrantoccurred.

She

reportedmild

fever.

Her

laboratory

findings

included

only

anelevated

total

white

blood

count

of

11.000/mm3

withoutelevated

proportion

of

eosinophils,

whereas

all

other

testswere

within

normal

ranges,

included

ultrasoundexamination.2021/9/920Right

lower

quadrant

tenderness

and

rigidy

were

foundon

abdominal

palpation.

Rovsing's

sign

and

examinationfor

rectal

tenderness

was

also

positive.

Due

to

thecombination

of

the

classic

symptoms

and

a

typicalprogression

of

symptoms

coupled

with

right

lowerquadrant

tenderness,

acute

appendicitis

was

suspectedand

surgical

removal

was

decided.At

pathological

examination,

microscopically

normalappendix

was

noted.This

was

confirmedhistopathologically.The

lumen

contained

parasites

withfeatures

compatible

with

Enterobius

vermicularis.2021/9/921The

diagnosis

was

parasitic

infestation

in

surgicalremoved

appendices.

After

the

recovery,mebendazole

for

the

affected

and

for

all

the

familymembers

was

prescribed.

A

single

dose

of

100

mgwas mended

and

the

patient

received

a

secondtreatment

after

15

days.2021/9/922鉤蟲Hookworm十二指腸鉤口線蟲（十二指腸鉤蟲）(Ancylostomaduodenale)美洲板口線蟲（美洲鉤蟲）(Necator

americanus)錫蘭鉤口線蟲犬鉤口線蟲

巴西鉤口線幼蟲移行癥larva

migrans鉤蟲病CausinghookwormdiseaseCreepingEruption2021/9/9232021/9/9242021/9/925Geographic

distribution全球約7.4億人感染，我國據(jù)推算約3930萬感染鉤蟲A. duodenale

(old

world

hookworm)

is

thedominant

species

in

the

Mediterraneanregion

and

northern

Asia.

(NorthernChina)N.

americanes

(new

world

hookworm)

is

mostcommon

in

the

Americas,

central

andsouthern

Africa,

southern

Asia(SouthernChina),

Indonesia,

Australia

and

PacificIslands.2021/9/926我國五大寄生蟲病之一農(nóng)村>城市南方>北方接觸泥土感染鉤蟲病hookworm

disease“黃胖病” “懶黃病”2021/9/927我國約3930萬感染者

20042021/9/928成蟲Adult:1cm

左右,

細(xì)長

slender,體型：“C”“S”形態(tài)Morphology2021/9/929發(fā)達(dá)的口囊buccal

cavity,Teeth

, cutting

plates咽部pharlynx2021/9/930頭腺1對(duì)

cephalic

glands,

抗血凝物質(zhì)

anticoagulant♂:末端擴(kuò)大（區(qū)別♀♂）交合傘copulatorybursa交合刺：末端分開、連合♀：十二指腸鉤蟲有尾刺開口于口囊兩側(cè)頭感器2021/9/9312021/9/932幼蟲（鉤蚴）桿狀蚴（rhabditiform

larva)絲狀蚴(filariform

larva)背腹各有一角質(zhì)矛狀結(jié)構(gòu)－口矛黑色桿狀2021/9/933蟲卵Egg:殼薄thin

shell,無色透明colorless,殼內(nèi)含4~8

卵細(xì)胞egg

cells.morula

stage2021/9/934LifecycleeggfirstAdult

(in

smallrhabditiform

Intestinal)larvaesecondrhabditiformlarvaeThe

juvenilesInthelungsfilariformlarvaeDevelop

under

temperature

of25~30C,

moist,

shadyMigrating

way

same

asAscaris

lumbricoides2021/9/93548h5~6d4th

molting5~7 weeks

needed生活史lifecycle1.基本過程1～2天7～8天桿狀蚴絲狀蚴成蟲

卵（小腸）30m

～1h皮膚粘膜泥土移行（同蛔蟲）童蟲（24小時(shí)后離開局部皮膚）上述過程需4～7周第一期桿狀蚴2021/9/936第二期桿狀蚴第三期桿狀蚴48h5~6d2.成蟲基本習(xí)性behaviour成蟲寄生部位—小腸position吸血為食suckingblood產(chǎn)卵量:eggs

output十二指腸鉤蟲：1-3萬/日美洲鉤蟲：0.5-1萬/日壽命：life

span

7年,

和15年2021/9/937適宜溫度3.蟲卵在外界發(fā)育特點(diǎn)development適宜環(huán)境：隱蔽、有氧的土壤2021/9/93822-26oC—十二指腸鉤蟲31-34oC—美洲鉤蟲4.

幼蟲larvae桿狀蚴

絲狀蚴：泥土表層（1-6

cm)向上性、向溫性和向濕的特性溫度適宜可存活6w5.感染方式modes

of

entry2021/9/939經(jīng)皮膚 Through

skin經(jīng)口 有轉(zhuǎn)續(xù)宿主Paratenichost經(jīng)乳汁

transmitted

by

milk經(jīng)胎盤by

transplacental2021/9/940四.致病Pathogenesis1.幼蟲larvae1)鉤蚴皮炎local

dermatitis(

ground

itch

)斑點(diǎn)、癢“糞觸塊”“著土癢”“糞毒”2)肺部損害pulmonary

symptoms,lesions（同蛔蟲）常見感染后3～5天內(nèi)咳嗽、哮喘2021/9/9412021/9/9422.成蟲adult(1)消化系統(tǒng)損害*

Intestinal

(infection)lesions機(jī)械性刺激mechanical 腹痛腸粘膜出血、潰瘍、炎癥（胃出血）bleeding腸吸收功能下降malfunction消化功能紊亂 disfunction

or

disturbance2021/9/943(2）貧血anemia

（缺鐵性貧血或低色素小細(xì)胞性microcytic

hypochromic

anemia

）機(jī)制：失血（吸血）

sucking

blood,美洲鉤蟲： 0.02-0.1ml/日/條十二指腸鉤蟲：0.14-0.4ml/日/條叮咬部位滲血oozed

blood(anticoagulant)更換叮咬部位usually

changes

its

sucking

site,造血原料未能吸收disfunction

of

intestine

to

absorb血紅蛋白合成速度比細(xì)胞新生速度慢2021/9/944鉤蟲咬附腸壁2021/9/9452021/9/9(3）異嗜癥（異嗜癖）aberration

of

appetite---allotriophagy46(4）嬰兒鉤蟲?。築aby’s

hookworm

disease尿布(diaper)、哺乳(suckling)、胎盤……多見出生后10～12月，以十二指腸鉤蟲感染為主(5）嗜酸性粒細(xì)胞增多癥eosinophilia2021/9/947allotriophagy2021/9/948Anemia2021/9/949診斷Diagnosis糞便檢查:WS

439-2013

鉤蟲病的診斷（中華人民共和國行業(yè)標(biāo)準(zhǔn)）飽和鹽水浮聚法saturated

brine

floatation

method直接涂片法direct

smear加藤涂片法Catos’smear鉤蚴培養(yǎng)法cultivation

of

hookworm

larvae其他Others:免疫學(xué)診斷

Immunological

test for

early

stageblood

test50

2021/9/9流行Epidemiology分布

distribution 世界性分布我國：長江以北十二指腸鉤蟲為主長江以南美洲鉤蟲為主混合感染區(qū)域 mixed

epidemic

region目前感染率下降趨勢(shì)明顯流行因素epidemicfactor

(1）傳染源infectious

sources病人+帶蟲者（多）(2）自然因素natural

factors與生產(chǎn)方式等農(nóng)作物有關(guān)Agricultural

productions,，未處理人糞施田fresh

humanstool

used2021/9/951赤腳或手工操作接觸泥土contact

earth

directly(3）社會(huì)因素socialfactors(4)礦山mining

pits.2021/9/952防治prevention

and

treatment1.治療病人chemotherapy對(duì)中度以上感染者先糾正貧血：補(bǔ)鐵劑和營養(yǎng)療法Dietary

supplementation.群體化療：全民性化療選擇性化療腸道線蟲感染率大于40％僅僅針對(duì)蟲卵陽性者或某些容易感染的人群。藥物:阿苯達(dá)唑Albendazole甲苯達(dá)唑Mebendazole三苯雙脒Tribendimidine2021/9/953對(duì)鉤蚴性皮炎者：(1）透熱療法Heat-therapy（接觸泥土后24小時(shí)內(nèi)）53oC熱水：浸泡20-30分鐘電吹風(fēng)electric

calefaction：吹3秒 停3秒碘酒2-3%

iodine：局部涂(2）15%噻苯咪唑軟膏局部涂敷(liniment)2021/9/954糞便管理Sanitary

disposal

of

fecal

wastes不用新鮮糞施肥,沼氣池naturalgaspit,封閉處理等 防止感染Protection

of

susceptible

individual1）避免與泥土直接接觸avoid

contact

2）不赤腳下地勞動(dòng),laboring

ways

3）涂驅(qū)避劑：liniment

used1.5%左旋咪唑硼酸酒精液2021/9/955Learning

guides:2021/9/956After

studying

this

chapter

the

student

should

be

able

todescribe

the

major

characteristics

of

life

cycle

of

both

parasitesIllustrate

why

pinworm

are

most

common

in

young

childrendemonstrate

the

reasons

of

hookworm

causing

severe

disease, and

especially

causing

anemiaList

the

major

laboratory

diagnosis

for

enterobiasis

and hookworm

diseasedescribe

the

major

epidemic

characteristics

for

both

parasitesCase

reportA

33-year-old

black

man

was

admitted

with

sharp

andcramping

upper

abdominal

pain

of

acute

onsetassociated

with

poor

appetite.

Physical

examination

waspositive

for

tendernesstopalpation

in

therightupperquadrant

with

involuntary

guarding

and

reboundtenderness.

Laboratory

tests

were

normal

except

for

anelevatedwhitebloodcountof16.8k/uL

with

54%neutrophils

and

29%

eosinophils

(absolute

4.65

k/uL).Abdominal

films

were

concerning

for

an

ileus

and

acomputed

tomography

scansh