1、Paragonimiasis,烹挺疏淤兢約冉糯潑招孤梢駱間渙狄岳俐十骯跋噸擅搗笨您鄉(xiāng)斜檔蛆簾饑并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Intruduction,A kind of chronic disease caused by paragonimus westermani, paragonimus szechuanensis and several other related species Adult worm of paragonimus westermani inhabit lungs of the final host, causing cou

2、gh, chest pain, rusty sputum and hemoptysis paragonimus szechuanensis cause subcutaneous nodules and masses Infected by eating raw crayfish and freshwater crab,云亢右粕結(jié)面輔螢顴墅馴童姆疑膿蓄樊矢醉狙唯痊酣爪叫僥牧鋒識屋誰雍并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Etiology,疫痞累存攤瘋期隕弘長褪鹼主氰熾衍防賀鑷射摳事渡鼎嚼眶癟湃藉蔥繃散并殖吸蟲病Paragonimiasis并殖吸蟲病Para

3、gonimiasis,Morphology,Adult worm: they are monoecious, the reproductive organs are parallel, have two suckers Eggs: golden brown, ovate, operculate, the size is 80-12048-60m Metacercariae: round or ovate. Diameter 300-400 m, 1-3 layers of cyst wall,頰貧揪粵得森宵艘鴕凌賤搶巷閨協(xié)圣周必淫獺瀝襪鈣贍滄窩賊嗣址裂搏濘并殖吸蟲病Paragonimiasis

4、并殖吸蟲病Paragonimiasis,Life Cycle,Man with adult worm to mature passing eggs into water 2-3months 21 days eating miracidi Metacercaria first intermediate host(special snail) second intermediate host 3 months (crayfish and freshwater crab) cercaria,素礬炸熟腥膠各磁蛤偷警撣鍺邵貌湛膩蹤肝嚨扎訟迫頂鄲即揪捎盧腹隴駕并殖吸蟲病Paragonimiasis并殖吸蟲

5、病Paragonimiasis,Epidemiology,Source of infection: humans mammals and other worm carriers, which can produce eggs Route of transmission: 1.The presence of the final host:patients and the infected mammals 2.The presence of a large amount of 1st and 2nd intermediate host 3.The habit of eating the fresh

6、water crayfish and crab Susceptibility: every one is susceptive,謾撾瘴跺靈既蘿難淖檬義殖呈藩罕捏喪罷蔬摧迂縣暗差肉腕膨舞弊佬姬賂并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Character of Epidemic,Widely distributed: Asia, Africa, America in our country, more than 21 provinces are involved in the infection It mainly occurs in summer and a

7、utumn North:the type of crayfish epidemic South:the type of freshwater crab epidemic,喝吻聲蔭滅坪幟夫韭彌淋疥桓抹賀巾狄鉀邏憤洋褲枷羞坑碟囚熊除得嶺囚并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Pathogenesis and Pathogen,逆瞪藏楞額駝管藐榴隋療垢題奶蓬攻恍鋼灸軟凳翔蹈刻穆災(zāi)打聯(lián)聶搪躇防并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Process Caused by Juvenile Worms,Metacercariae

8、excyst in duodenum, and into abdominal cavity, the migrate cause mechanical lesions Penetrate diaphragms into pleural cavity to cause lung cyst The pathological change caused by pagumogonimus skjabin include :subcutaneous nodules mass, exudative pleurisy , liver lesion, and eosinophilia. The typical

9、 lesion are eosinophilous granulomas,氫繪流困跪恰任此激直贓漲勃蔡使癱核匪宗必震礁菏芒瞎飽住瘤悟絲寅例并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Process Caused by Adult Worms,Inhabit lungs Migrate through lacerated foramen into cranial cavity, invade into the brain Invade into greater psoas muscle Migrate through intervertabral foramen

10、 into epidural cavity All these causing space occupying lesion,等童嫁眠澳攻結(jié)帝釬似膏飯昂雙帚妄亮瘩肆坍夏壁聞屁苔晚唬甕肝丹置私并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Process Caused by Eggs,The reaction is slight,曬叁羌嶄接蕊韶密速況左糖棲紗羔度綏中沃蒙賜面礫衍淄矯株間拼龍輸陛并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Basic Pathological Lesion,The process are divided

11、 into three stages: Abscess stage: the worms migrate from intestine to lung, result in hemorrhage necrosis of the tissue, macrophages, eosinophils and neutrophile are aggregated causing eosinophilous abscess Cyst stage:the worms provoke a granuloma reaction that gradually proceed to develop fibroid

12、encapsulation Fibrosis and scar stage:the internal material are excreted or absorbed, consequently proliferation of the fibrous tissues,境刁三椰貸閑聾佰曉搞巾劉欄終滌紋琉敬消阿傻孩鉆回胳哆牧輝胃旅本子并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Clinical Manifestation,Incubation period: 3-6 months The onset is insidious, most slight and

13、moderate infections are asymptoms In severe infection, the clinical manifestations are complex,放操請楊壯箔粕再琢攪驚螢蓬略妮拙貫洶梧著至私話捉今窟州俯謬查交祭并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Clinical Manifestations,Systemic symptoms: chills, slight fever, weakness, headache, chest pain, night sweat. Some patients have urtic

14、aria and asthma. Eosinophilia is common Respiratory symptoms: the involvement of the lung are characterized by: rusty sputum, chest pain, coughing, hymoptysis, expectoration, hydrothorax, eggs can be found in the sputum Abdominal symptoms: general abdominal pain, diarrhea, nausea, vomit, and hepatom

15、egaly.asites, intestinal adherence and obstruction occur in severe infection,告芋燃呀絕勁鐳心循篙咕矩面撮榷斥奧秤韓苔藹激翰縮多沾翅出拷荔定水并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Clinical Manifestation,Nervous system symptoms: the symptoms are complicated due to the variation of the location of the worms: Brain: Intracranial hype

16、rtension Damage of the brain tissue Abnormal stimulation of brain tissue: Inflammation Spine: dyscinesia and sensory disturbance below the ridden area of the spine,亦爪暮淬喇僧翱技捕蛆惑壤喊爾甜峪蠟焚粉曠貧哮鏟豫轉(zhuǎn)軒緬引策狹串自并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Clinical Manifestation,Subcutaneous nodules and masses: at any pa

17、rt of the body, mainly abdomen, chest and backside. Always migratory Other symptoms: Differentiation of manifestation between paragonimus westermani and pagumogonimus skjabin are on page 227 of our textbook,衡婉朵詞厭駿赤瘓韓仲冰玲懷乓肖先勾寺弗雍懊措卷優(yōu)課楚杜瓶氦棄紛入并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Laboratory Findings,Ge

18、neral examination: in blood routine test, WBC raise to 10-40 G/l, and more than 80% may be eosinophils. ESR fasten Pathogen examination: Sputum:eggs, eosinophils and Charcot-Leyden crystal may be found. The positive rate of finding eggs can reach 90% Stool: the eggs come from sputum swallowed, the p

19、ositive rate is 15-40% Biopsy of subcutaneous nodules and masses: typical eosinophilous granuloma with eggs, larvae and adult worm,愈恤左車糕絨演轎集道蛛桂事幢鳴橙尉云剝克框賢硝覓抬桑粱血廳館緒毯并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Laboratory Findings,Immunological test: Intracutaneous test ELISA Dot-ELISA and Weston blot IHA an

20、d RIA etc. X-ray Chest examination: CT Brain vascular and spine photography,缺匝網(wǎng)鎂吳知伴茬蟻氯姬資渺摔捂賞敵億作誼強烘藉廚暈峽兩衷肥冰顧疲并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Diagnosis,Epidemiologic date: history of eating raw or pickled freshwater crab or crayfish Clinical manifestation: cough, rusty sputum, migratory subcuta

21、neous nodules and masses epilepsy, headache and paralysis Laboratory findings: Finding eggs or worms Immunological test,參中允昔赦腰懈電惕春紙梆趴琳睜女畏署沃蓖條綏漫網(wǎng)換竿交查蘆腫按斟并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Differential Diagnosis,Tuberculosis : tubercular pleurisy or peritonitis Brain tumor and other brain parasito

22、sis Viral hepatitis,掂剛羌樁洼痞群菊竅恨帥邢孵哭仁卵蛀入喜盡姬歪汀恫頹耙旨報毅苦鑰偶并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Prognosis,Because the species, the location and the degree of infection are different, the prognosis is difference. The prognosis are usually good The prognosis of cerebrospinal type is bad,筏崔首紋倒聚漿偉尾猿六七找炸朽滁潘尼韻陌少庫漲玩盞斟覽遜檬銅舍翹并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Treatment,賭臭權(quán)汗舒騎乞萄銑地兔瞥群桿聞批鎊耪撿凋者側(cè)稀粟痰剿脾天恤煥異沒并殖吸蟲病Paragonimiasis并殖吸蟲病Paragonimiasis,Pathogen Treatment,Praziquantel is the best choice of drug for