二蛲虫钩虫蠕形住肠线虫

蛲虫病Causing

enterobiasis蠕形住肠线虫

蛲

虫Enterobius

vermicularis

pinworm2021/9/91全球分布比例我国以江苏、福建省感染率最高人为唯一的传染源2021/9/92成虫Adult:♀

8

─13mm♂

2

─

5mm针状pin-like,乳白white,三个唇瓣three

lips,头翼cephalic

alae,咽管球a

pharyngeal

bulb.雌虫female:雄虫male:形态Morphology2021/9/932021/9/94虫卵Egg:卵圆Oval,无色colorless,一端扁平flattened

on

one

side,一条蝌蚪状幼虫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.生活史成虫

卵

感染期虫卵(大肠)

（肛周）

(经口、吸入感染)幼虫夜间肛周产卵寿命：<2个月

(life

span)（小肠内蜕皮二次）2-4周（十二指肠孵出）6小时产卵后雌虫3个结局2021/9/982021/9/99致病Pathogenesis1.

局部症状local

symptom肛门搔痒Crawling

sensation

and

anal

pruritus2.

全身症状general神经系统:

烦躁irritable,

夜惊nightmare,

失眠

insomnia消化系统症状:.2021/9/9103.

异位寄生2021/9/911•阴道炎Vaginitis,输卵管炎salpingitis.并发症Complications:••蛲虫性阑尾炎appendicitis

withenterobiasis,泌尿生殖系统urogenital

and

pelvicinflammation诊断Diagnosis:1.

查虫卵：肛周(around

anus)《蛲虫病的诊断》(WS

469-2015)

中华人民共和国我国行业标准1)

透明胶纸法Cellophane

tape

impression2)

肛门棉纤拭子法Scotch

tape

swabs and

cotton

swabs注意:检查时间checking

time部位

position2.找成虫:肛周(夜间)Finding

of

female

worm2021/9/9122021/9/9132021/9/9142021/9/915流行Epidemiology:托儿所Kindergarten,全球感染者不少于5亿人口手食物玩具口,Anus-to

mouth

by分布distribution:世界性

城市

>

农村儿童>成人（5～7岁）传播方式肛门经口感染污染fingers吸入感染虫卵轻,可暂时性悬浮空间Air-borne

eggs

,近年来下降趋势明显2021/9/916自身感染Auto-infection.防治Prevention

and

treatment:1.

讲究卫生Personal

and

group

hygiene个人卫生：personal

hygiene洗手、剪指甲、不穿开裆裤……公共卫生: communal

hygiene托儿所玩具消毒sterilization

,0.05%碘液消毒玩具浸泡1小时或太阳下曝晒(insolate)2021/9/9172021/9/9182.治疗病人Treatment:有计划、定期对集体机构检查和治疗药物:1)口服:阿苯达唑Albendazole,甲苯咪唑Melbendazole噻嘧啶Pyrrinium

pamoate,2)

外用:

蛲虫膏

ointment

used2%白降汞膏(white

precipitate

ointment)龙胆紫(alkalescene

dye)止痒杀虫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.2021/9/922钩虫Hookworm十二指肠钩口线虫（十二指肠钩虫）(Ancylostomaduodenale)美洲板口线虫（美洲钩虫）(Necator

americanus)锡兰钩口线虫犬钩口线虫

巴西钩口线幼虫移行症larva

migrans钩虫病CausinghookwormdiseaseCreepingEruption2021/9/9232021/9/9242021/9/925Geographic

distribution全球约7.4亿人感染，我国据推算约3930万感染钩虫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我国五大寄生虫病之一农村>城市南方>北方接触泥土感染钩虫病hookworm

disease“黄胖病” “懒黄病”2021/9/927我国约3930万感染者

20042021/9/928成虫Adult:1cm

左右,

细长

slender,体型：“C”“S”形态Morphology2021/9/929发达的口囊buccal

cavity,Teeth

, cutting

plates咽部pharlynx2021/9/930头腺1对

cephalic

glands,

抗血凝物质

anticoagulant♂:末端扩大（区别♀♂）交合伞copulatorybursa交合刺：末端分开、连合♀：十二指肠钩虫有尾刺开口于口囊两侧头感器2021/9/9312021/9/932幼虫（钩蚴）杆状蚴（rhabditiform

larva)丝状蚴(filariform

larva)背腹各有一角质矛状结构－口矛黑色杆状2021/9/933虫卵Egg:壳薄thin

shell,无色透明colorless,壳内含4~8

卵细胞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.基本过程1～2天7～8天杆状蚴丝状蚴成虫

卵（小肠）30m

～1h皮肤粘膜泥土移行（同蛔虫）童虫（24小时后离开局部皮肤）上述过程需4～7周第一期杆状蚴2021/9/936第二期杆状蚴第三期杆状蚴48h5~6d2.成虫基本习性behaviour成虫寄生部位—小肠position吸血为食suckingblood产卵量:eggs

output十二指肠钩虫：1-3万/日美洲钩虫：0.5-1万/日寿命：life

span

7年,

和15年2021/9/937适宜温度3.虫卵在外界发育特点development适宜环境：隐蔽、有氧的土壤2021/9/93822-26ºC—十二指肠钩虫31-34ºC—美洲钩虫4.

幼虫larvae杆状蚴

丝状蚴：泥土表层（1-6

cm)向上性、向温性和向湿的特性温度适宜可存活6w5.感染方式modes

of

entry2021/9/939经皮肤 Through

skin经口 有转续宿主Paratenichost经乳汁

transmitted

by

milk经胎盘by

transplacental2021/9/940四.致病Pathogenesis1.幼虫larvae1)钩蚴皮炎local

dermatitis(

ground

itch

)斑点、痒“粪触块”“着土痒”“粪毒”2)肺部损害pulmonary

symptoms,lesions（同蛔虫）常见感染后3～5天内咳嗽、哮喘2021/9/9412021/9/9422.成虫adult(1)消化系统损害*

Intestinal

(infection)lesions机械性刺激mechanical 腹痛肠粘膜出血、溃疡、炎症（胃出血）bleeding肠吸收功能下降malfunction消化功能紊乱 disfunction

or

disturbance2021/9/943(2）贫血anemia

（缺铁性贫血或低色素小细胞性microcytic

hypochromic

anemia

）机制：失血（吸血）

sucking

blood,美洲钩虫： 0.02-0.1ml/日/条十二指肠钩虫：0.14-0.4ml/日/条叮咬部位渗血oozed

blood(anticoagulant)更换叮咬部位usually

changes

its

sucking

site,造血原料未能吸收disfunction

of

intestine

to

absorb血红蛋白合成速度比细胞新生速度慢2021/9/944钩虫咬附肠壁2021/9/9452021/9/9(3）异嗜症（异嗜癖）aberration

of

appetite---allotriophagy46(4）婴儿钩虫病：Baby’s

hookworm

disease尿布(diaper)、哺乳(suckling)、胎盘……多见出生后10～12月，以十二指肠钩虫感染为主(5）嗜酸性粒细胞增多症eosinophilia2021/9/947allotriophagy2021/9/948Anemia2021/9/949诊断Diagnosis粪便检查:WS

439-2013

钩虫病的诊断（中华人民共和国行业标准）饱和盐水浮聚法saturated

brine

floatation

method直接涂片法direct

smear加藤涂片法Catos’smear钩蚴培养法cultivation

of

hookworm

larvae其他Others:免疫学诊断

Immunological

test for

early

stageblood

test50

2021/9/9流行Epidemiology分布

distribution 世界性分布我国：长江以北十二指肠钩虫为主长江以南美洲钩虫为主混合感染区域 mixed

epidemic

region目前感染率下降趋势明显流行因素epidemicfactor

(1）传染源infectious

sources病人+带虫者（多）(2）自然因素natural

factors与生产方式等农作物有关Agricultural

productions,，未处理人粪施田fresh

humanstool

used2021/9/951赤脚或手工操作接触泥土contact

earth

directly(3）社会因素socialfactors(4)矿山mining

pits.2021/9/952防治prevention

and

treatment1.治疗病人chemotherapy对中度以上感染者先纠正贫血：补铁剂和营养疗法Dietary

supplementation.群体化疗：全民性化疗选择性化疗肠道线虫感染率大于40％仅仅针对虫卵阳性者或某些容易感染的人群。药物:阿苯达唑Albendazole甲苯达唑Mebendazole三苯双脒Tribendimidine2021/9/953对钩蚴性皮炎者：(1）透热疗法Heat-therapy（接触泥土后24小时内）53ºC热水：浸泡20-30分钟电吹风electric

calefaction：吹3秒 停3秒碘酒2-3%

iodine：局部涂(2）15%噻苯咪唑软膏局部涂敷(liniment)2021/9/954粪便管理Sanitary

disposal

of

fecal

wastes不用新鲜粪施肥,沼气池naturalgaspit,封闭处理等 防止感染Protection

of

susceptible

individual1）避免与泥土直接接触avoid

contact

2）不赤脚下地劳动,laboring

ways

3）涂驱避剂：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