一-07吸虫1972年东郊一座汉朝墓葬横空出世相传2000多

1972年湖南沙市东郊一座汉朝墓葬的横空出世。相传2000多年前楚王马殷的墓地，故称“马王堆”。1号墓女尸经医学家临床检验：结缔组织、肌肉组织和软骨等细微结构保存完好，全身有柔软的弹性，皮肤细密而滑腻，部分关节可以转动，甚至手足上的纹路也清晰可见。病理解剖检查发现，死者生前患有冠心病、多发性胆石症、全身性动脉粥样硬化症，右上肺有结核病灶，右前臂曾经骨折，在直肠和肝脏内有鞭虫卵、蛲虫卵和血吸虫卵。送瘟神（二首）—读六月三十日

，余江县消灭了血吸虫。浮想联翩，夜不能寐。微风拂煦，旭日临窗。遥望南天，欣然命笔。其一枉自多，华佗无奈小虫何？千村薜苈人遗矢，万户

鬼唱歌。坐地日行八，巡天遥看一千河。牛郎欲问瘟神事，一样悲欢逐逝波。其二春风杨柳万千条，六亿神州尽舜尧。红雨随心翻作浪，青山着意化为桥。天连五岭银锄

动三河铁臂摇。借问瘟君欲何往？纸船明烛照天烧。ThebloodflukesFive

schistosome

species

pathogenic

to

humans:S.

japonicum,

S.

mansoni,

S.

haematobium,S.

mekongi

and

S.

intercalatum.Despite

the control

progress,

the

disease

remains

endemicin

74

countries.Of

200

million

infected

people,

20

million

suffer

severeconsequences

from

the

disease

and

120

million

areasymptomatic.

Globally,

500-600

million

people

are

atthe

risk

of

infection.候选

：GST,

Sm97,

IrV-5,

TPI,

Sm23,

Sm14……SchistosomeThree

species

of

Schistosomes

that

parasitize

humans

are

maiorimportance:

Schistosoma

japonicum,

S.mansoni,

&

S.haematobium.Lesscommon

are

S.intercalatum

in

Africa

and

S.

mekongi

in

theMekong

Basin.The Schistosomes

differ

from

other

trematode

in

thatthe

adult

worms

are

dioeciousthe

adult

worms

parasitize

blood

vesselsthey

produce

non-operculateeggsthe

cercaria,

with

a

bifurcated

tail,

invades

the

final

hostpercutaneously血吸虫(Schistosoma)又称裂体吸虫，寄生

主要有五种虫种

寄生部位虫卵分布血吸虫曼氏血吸虫埃及血吸虫肠系膜V肠系膜小V、痔V丛V丛肠壁及肝、肠系膜肠壁、肝、

官肠壁、肝间插血吸虫湄公血吸虫肠系膜V、门脉系统肠系膜上V、门脉系统Schistosoma

mansoni

-

adults

occur

in

the

posteriormesenteric veins

of

the

large

intestineSchistosoma

japonicum

-

adults

occur

in

the

anteriormesenteric

veins

of

the

small

intestineSchistosoma

haematobium-

adults

occur

in

the

veinsof

the urinary

bladderSpeciesHabitat

in

hostMajor

organ

involvementS.japonicumS.mansoSurperior

mesenteric

veinnferior

mesenteric

veinintestines

/liverintestine

/liverbladder/uretersintestine

/liverintestines

/liverS.haematobium

Vesical

venous

plexusS.intercalatumS.mekongiInferior

mesenteric

veinSurperior

mesenteric

veinDistinguishing

of

Schistosome

Species曼氏血吸虫埃及血吸虫血吸虫曼氏血吸虫卵埃及血吸虫卵血吸虫卵S.

haematobiumS.

mansoniS.

japonicumMorphologythe

adultworms

are

dioeciousworm: #

white,short&wider

than

female

worm,#

7

testes

are

usually

presenton

the

dorselside

just

below

the

ventral

sucker#

the

gynecophoral

c#oral

sucker

is

smaller

than

ventralAdult:MaleFemale

worm:held

in

the

gynecophoral

cthe

uterus

is

a

long

straight

tube

andopens

behind

the

ventralsuckerEgg:ovoid, non-operculate, contain

one

miracidium,

knobaThe

life

cycle

of

S.japonicum

follows

apathway

from

the

sexualgeneration of

adult

worm

within

the

portalsystem

of

thedefinitivehost

to

asexual generation

in

the

intermediate

host

of

freshwaterelania

hupensis,

anda

return

to

the

definitive

host

byskin penetration

ofinfective

stage----

cercariaeAdultEgg fresh

water

MiracidiumSporocystDaughtersporocystparasitize

in

themesenteric

veindischarged

in

fecespenetrating

the

skinlost

the

tailSchistosomulumCercariaEgg

of

Schistosomajaponicum.

No

spinecanbe

seen.

85

m

x

60

m.虫卵产出和发育(Deposition

&

development

of

eggs)adult

inhabit

in

branchesof

portal

system

&

mesenteric

veinseggs

deposition

insmall

perivascular

tissues

of

the

intestineand

liver

(about

24

days

in

total)take

11

days

for

the

egg

to

mature

&

survives

in

tissue

foranother

tendays

(21

to22daysintotal)the

substance

secretedbymiracidium,the

eosinophilic

abscessformationin

intestine

mucosa,ulceration…eggs

escapeand

discharged

into

intestinal

c毛蚴孵化(Hatching

of

miracidium,multiplication

in

snail)孵出因素：水清quality

of

water温度

temperature <10

℃

or

>37

℃

hatching

will

be

inhibited光线lightpH:

7.5—7.8含氯>0.3ppm

inhibitmiracidium

canfree-living

for

3

days

beforeentertissue

of

snailmiracidia hatch

fromthe

eggs,

rapidly

swim

by

means

of

ciliaand

penetrate

the

body

of

snail---intermediate

host‘miraxone’—吸引毛蚴在其头足部毛蚴在螺体内的发育和繁殖尾蚴逸出的条件：水及pH

pH6.6-7.8温度20℃

to

25℃光线

The

peak

time

: 8am-12

pmthousands

of

cercariae

from

a

single

miracidium尾蚴逸出后50%在螺附近，作尾部 ，体部在后运动一般25.4hr，最长为50hr尾蚴侵入infective

stagepenetrate

skin

or

mucous

membrane

bypenetration

glands

&

mechamical

vibrationof

tailMaturation

ofwormpenetration

thecercarialoses

tail,

body

formedschistosomulaperipheral

venules right

heart

lungleft

heart intrahepatic

portal

system mesenteric

venulaEggs

appear

in

feces

5-6weeks

after

cercarial

penetrationPathogenicity基本病变Schistosomiasis

may

occur

at

each

of

themajor

stage

parasitelife

cycle1.

尾蚴所致病变cercaria

penetration:

dermatitisrepeated

exposure

leads

to

sensitizationdevelopment

of

a

maculopaular

rashIgE

or

IgG

antibodies

&

eosinophilic

infiltrateThigh

ofa

child

with

amaculopapular

rash(“swimmer’s

itch”)

fromcercariae

ofschistosome

speciesthat

normally

infectsbirds.2.童虫所致病变schistosomula

migration

&

maturation: toxic

reaction,pulmonary

congestion panied

by

fever,vasculitis3.成虫所致病变Adult

worm: release

immunogens

from

intestine,tegument,

& excretory

system-----immunopathologicalresponse,

immuno-nephropathyeggs:

profound

immunopathogenic

responsealmost

all

pathology

&

symptoms

of

schistosomiasisS.

japonicum

egg

deposition in

circulation

of

smallintestine

&

liver

→

intestinal

&

hepatic

fibrosisSchistosome

egg

in

tissueof

small

intestine虫卵所致损害：是最主要和最重要的损害肉芽肿→组织增生纤维化肠：虫卵沉积→嗜酸性粒细胞浸润→嗜酸性脓肿溃破→粘液血便、腹痛腹泻肝：虫卵沉积→嗜酸性粒细胞浸润→嗜酸性脓肿→肉芽肿→纤维组织增生腹水、脾肿大、静脉曲张←门静脉高压←肝纤维化巨脾型 腹水型结肠增殖型

侏儒型The

liverthe

soluble

antigenicsubstance

secreted

bymiracidiumeosinophilicinfiltrationeosinophilicabscessgranulomasplenomegalyascitesvenous

varicesfibrosiscirrhosisportalhypertensionesophageal

varicescaput

medusaehemorrhoid

venous

varicesInintestineThe

soluble

antigenicsecreted

by

miracidiumdiarrheaeosinophilicinfiltrationeosinophilicabscessfibrosisBrain

formepileptic

seizuresDwarfismsevere

disturbance

of

growth

in

childrenulcerationgranulomaAcute

inflammation---

the

antigenelicit

result

fever,

abdominal

pain,enlarged

tender

liver

and

spleen,

or

discharge

of

eggs

into

intestinalc panied

bydysentery

or

diarrheaThe

egg

soluble

antigen

can

inducehos sitization

of

T

cell

andrecruitment

of

macrophages,

lymphocytes,

epitheliod

cell,

firoblasts,and

numerous

eosinophils

to

forminflammatory

granulomaThe

antigenic

secretion

stops

when

the

miracidium

within

the

eggdies,

granuloma

then

undergo

a

healing

process

with

depositionoffibrous

tissue临床表现急性血吸虫病：季节性，第一次

而无免疫力人群多见慢性血吸虫病：无症状者和有症状者之分晚期血吸虫病：最严重、危害最大的损害巨脾型腹水型结肠增殖型侏儒型Acute

schistosomiasis

(fever,

syndrome)most

commonly

in

new

immigrantsintense

exposure

to

S.

japonicum

cercariae~4-8weeks

after

exposure

(adult

worms

releaseeggs)symptoms

are

flu-likecough

&headachefever

&

eosinophiliahepatosplenomegalylymphadenopathyChronic

schistosomiasismany

years

of

progressiveinjury

(chronic

egg

deposition)→

granuloma

formation

in

tissuesextent

of

injury

dependson

chronic

worm

burdenS.japonicum

injury

from

eggs

inintestine

wallliver

parenchyma→

chronic

intestinal

&

hepatic

dysfunctionChronic

childhood

schistosomiasisabdominal

pain,

diarrhea,

blood

loss

&

intestine

ulcerationmay

cause

iron

deficiency

&

anemiaphysical

growth

retardation

(like

intestinal

nematodes)stunting

reversible

with

anthelminthic

therapy肝脾肿大肝硬化：贫血:成虫吞噬、脾功能亢进、毒性物质作用、自身免疫水肿:肝功能下降、白蛋白下降、血浆胶体渗透压下降、血管内液体外漏血流受阻，血浆溢出激素降解减少、水钠储留肾小球受损，蛋白质滤过增加静脉曲张:

食道、痔上、腹壁侏儒症:垂体、肾上腺、 、甲状腺等萎缩、功能不足异位损害:脑血吸虫病、肺血吸虫病hepatomegaly

due

to

portal

fibrosis

→

splenomegaly

followsadvanced

cases:

spleen

may

fill

much

of

left

side

of

abdomenportal

hypertension→development

of

collateral

circulation

→侧支循环schistosome

eggs

washed

into

lungs

→induce

granulomatous

inflammation

→leads

to

obstructive

diseaseleads

to

cor

pulmonale

（肺源性心脏病）long-standing

infections

causes

nephrotic

syndromedeposition

ofimmune

complexes

in

kidney—血吸虫性肾病CNS

schistosomiasis

(schistosomes

causeinflammation

in

CNS)rare

cases:

deposition

of

eggs

in

spinal

cord

orbrain

→inflamation

→focal

transverse

myelitis

&

encephalopathy--血吸虫性脑病Immunity性免疫

获得性免疫itantimmunity:of

adult

schistosomes

shohosts

carrying

an

initial

infectionrtial

but

significant

protectionto

a

cercarial challenge

infection.immuno-evasion:

the

schistosomes

can

evade

the

hostimmune response

------the

adult

worm

acquire

host

antigenon

its

surface

，

occluding

antibody

,

membrane

modificationDiagnosis病原stool

specimens---microscope

examination---eggs

cannot

be

detectedin

stool

during

the

worm

mature,very

light

and

chronic

infection,

eggmay

be

very

difficult

to

detect

in

stool

---直接涂片法Sedimentation

hatching mended

--沉淀孵化法Kata-katz

method- mended

----定量透明法

(Kata-katz

)rectal

biopsy----直肠粘膜活检免疫皮内试验Circumoval

pricipitin

test

(COPT)Antibody

detection--- ELISA:

crude

adult

worm

extract egg

antigenImmunoblotFast

do

ISAAntigen

detection----循环抗原检测Integration

or

Combination

of

diagnostic

method---综合查病国家人类

组南方 主持协同有关部门单位经过5年多的艰苦奋战，完成了

血吸虫

组

和基因功能分析工作，相关

16日在Nature上目前，血吸虫病仍在包括中国在内的76个国家中流行，尤其在一些发展中国家还有蔓延的趋势，严重危害人民的健康。血吸虫除了有大量与其他物种同源的外，还有许多血吸虫特有。这为认识血吸虫生物学特征、开发抗血吸虫药物以及研制血吸虫奠定了理论基础。Epi