并殖吸虫病Paragonimiasis课件

ParagonimiasisIntruductionAkindofchronicdiseasecausedbyparagonimuswestermani,paragonimusszechuanensisandseveralotherrelatedspeciesAdultwormofparagonimuswestermaniinhabitlungsofthefinalhost,causingcough,chestpain,rustysputumandhemoptysisparagonimusszechuanensiscausesubcutaneousnodulesandmassesInfectedbyeatingrawcrayfishandfreshwatercrabEtiologyLifeCycleManwithadultwormtomaturepassingeggsintowater2-3months21dayseatingmiracidiMetacercariafirstintermediatehost(specialsnail)secondintermediatehost3months(crayfishandfreshwatercrab)cercariaEpidemiologySourceofinfection:humansmammalsandotherwormcarriers,whichcanproduceeggsRouteoftransmission:

1.Thepresenceofthefinalhost:patientsandtheinfectedmammals2.Thepresenceofalargeamountof1stand2ndintermediatehost3.ThehabitofeatingthefreshwatercrayfishandcrabSusceptibility:everyoneissusceptiveCharacterofEpidemicWidelydistributed:Asia,Africa,Americainourcountry,morethan21provincesareinvolvedintheinfectionItmainlyoccursinsummerandautumnNorth:thetypeofcrayfishepidemicSouth:thetypeoffreshwatercrabepidemicPathogenesisandPathogenProcessCausedbyAdultWormsInhabitlungsMigratethroughlaceratedforamenintocranialcavity,invadeintothebrainInvadeintogreaterpsoasmuscleMigratethroughintervertabralforamenintoepiduralcavityAllthesecausingspaceoccupyinglesionProcessCausedbyEggsThereactionisslightClinicalManifestationIncubationperiod:3-6monthsTheonsetisinsidious,mostslightandmoderateinfectionsareasymptomsInsevereinfection,theclinicalmanifestationsarecomplexClinicalManifestationsSystemicsymptoms:chills,slightfever,weakness,headache,chestpain,nightsweat.Somepatientshaveurticariaandasthma.EosinophiliaiscommonRespiratorysymptoms:theinvolvementofthelungarecharacterizedby:rustysputum,chestpain,coughing,hymoptysis,expectoration,hydrothorax,eggscanbefoundinthesputumAbdominalsymptoms:generalabdominalpain,diarrhea,nausea,vomit,andhepatomegaly.asites,intestinaladherenceandobstructionoccurinsevereinfectionClinicalManifestationNervoussystemsymptoms:thesymptomsarecomplicatedduetothevariationofthelocationoftheworms:Brain:IntracranialhypertensionDamageofthebraintissueAbnormalstimulationofbraintissue:InflammationSpine:dyscinesiaandsensorydisturbancebelowtheriddenareaofthespineLaboratoryFindingsGeneralexamination:inbloodroutinetest,WBCraiseto10-40G/l,andmorethan80%maybeeosinophils.ESRfastenPathogenexamination:

Sputum:eggs,eosinophilsandCharcot-Leydencrystalmaybefound.Thepositiverateoffindingeggscanreach90%

Stool:theeggscomefromsputumswallowed,thepositiverateis15-40%

Biopsyofsubcutaneousnodulesandmasses:typicaleosinophilousgranulomawitheggs,larvaeandadultwormLaboratoryFindingsImmunologicaltest:

IntracutaneoustestELISADot-ELISAandWestonblotIHAandRIAetc.X-ray

Chestexamination:CTBrainvascularandspinephotographyDiagnosisEpidemiologicdate:historyofeatingraworpickledfreshwatercraborcrayfishClinicalmanifestation:

cough,rustysputum,migratorysubcutaneousnodulesandmassesepilepsy,headacheandparalysisLaboratoryfindings:FindingeggsorwormsImmunologicaltest

PrognosisBecausethespecies,thelocationandthedegreeofinfectionaredifferent,theprognosisisdifference.TheprognosisareusuallygoodTheprognosisofcerebrospinaltypeisbadTreatmentPathogenTreatmentPraziquantelisthebestchoiceofdrugforthetherapyofparagonimiasisDose:25mg/kg,threetimesaday,for2-3days,thebraintypeneed2timestherapy,theintervalis7daysTheotherdrugsf