囊尾蚴病课件

ScrubTyphus

（恙虫病）

Definition

Acutefebrileinfectiousdisease

CausedbyRickettsiatsutsugamushi

TransmittedbythebiteofchiggersSourceofinfection:Rats

Characterizedbyfever,eschar,rash,andlymphadenopathyEtiologyIntracellularorganism

Propagatedinmice,somecellsAntigenicallydiversemicroorganismCommonantigenwithProteusOX-KLowresistanceEpidemiology▲

Sourceofinfection:Rats▲

Vector:MiteThelifecycle:ovum,larva,pupa,naiadandimagoOnlyitslarva(chigger)feedingonhumansimago

larvaratpupanaiadimagoovumlarvaratpupa

naiad第一代第二代(遗传、传染)ThelifecycleofmitebiteovumEpidemiologyProliferateinwarm,wetenvironmentsBothavectorandareservoir▲

Routeoftransmission:biteofchigger▲

Susceptibility:universal▲

Immunity:long-lastingimmunityagainstthehomologousstrains;Partialimmunityagainsttheotherheterologousstrains

Epidemiology▲Otherepidemiologicalfeatures:Geographicdistribution:Asian-pacificregionSporadicSeasonaldistribution:rainyseasonsbetweenMayandNovemberPathogenesis

humanbodyrickettsemiaeschar

localsiterickettsia

mitevasculitisrats

PathologyBasiclesion:

inflammationofthewallsofthesmallbloodvesselsPathologicfindings:

eschar,lymphadenopathy,rash,enlargementofspleenandliverSeriouspathologicmanifestations:

myocarditis,meningoencephalitis,pneumonia,interstitialnephritisClinicalmanifestations

Incubationperiod:4～21daysSuddenonset,

Highfever:remittentfeveraccompaniedbychill,headache,malaise,prostration,poorappetite.Clinicalmanifestations

Signsofmultiorgandamage:Meningoencephalitis:delirium,convulsion,coma,andneckstiffness.Interstitialpneumonia:cough,chestpain,breathlessness.Clinicalmanifestations

Signsofmultiorgandamage:

Myocarditis:galloprhythm,poorqualityheartsounds,systolicmurmurs.Hepatitis:jaundice,hemorrhage.Naturalcourse:

2～3weeks.

Characteristicmanifestations

⒈Escharandulceration:Characteristicsign.Seenin36.9～98％ofpatients.Generallylocatedinwarm,wet,intensesmelledareas.eschareschar

ulceration

Characteristicmanifestations

2.Lymphadenopathy:Enlargedmarkedlyregionallymphnodesneartheeschar.Generalizedlymphadenopathy.Painful,movable,notpurulent.

Characteristicmanifestations

3.Rash:Appearsonthe4thtothe6thday.Beginningonthetrunk,spreadtotheextremities.Maculopapular,congestive,noitching.Lasting3～7days.Seenin35～100％ofpatients.

Characteristicmanifestations4.SplenomegalyandhepatomegalySplenomegaly:30～50％ofpatients.Hepatomegaly:10～20％ofpatients.

Complications

Pneumonia,myocarditis,

hepatitis,DIC.

Diagnosis

⒈EpidemiologicdataHistoryofexposuretoendemicareas.Rainyseason.Diagnosis

2.ClinicalfeaturesAbruptonsetoffever.Accompaniedwithchill,lymphadenopathy,rash,enlargementofspleenandliver.Mostcharacteristicsign:eschar.Therapeuticdiagnosis.Diagnosis

3.LabfindingsA.Routinelabdata:

WBC↓liverenzymevalues↑proteinuria.

B.Serologicaltests

①Weil-FelixreactionDiagnosis

①Weil-Felixreaction:Positiveresultobtainedfromthe4thday.Higherthan1:160issuggestive.Availableandinexpensive.About50％ofpatientshavediagnostictiters.

Diagnosis

②

Complementfixationtestandindirectimmunofluorescentantibodytest:MoresensitiveandspecificthanWeil-Felixreaction.Fourfoldorgreaterincreaseinconvalescence.Rarelyusedbecauseofthedifficultinpreparingantigens.Diagnosis

C.IsolationoforganismBloodinoculatingintomice.Organismfoundinmononuclearcells.Specifictesttoconfirmthediagnosis.Can’tgivearapiddiagnosis.Diagnosis

D.MolecularbiologicassaysNucleicacidhybridizationandPCR.Greatpotentialforsensitiveandspecificdetectionofnucleicacid.Beingevaluated.Limitationoftechniqueandfacilitiesconditions.

DifferentialDiagnosis

Otherrickettsialdiseases,typhoidfever,leptospirosis,malaria,dengue,septicemia,influenzaPrognosisFatalityrate:9～60％withouttreatment.<5％effectivetreatment.Treatment

Chloramphenicol,tetracycline,doxycycline

Chloramphenicol:1.5～2gdaily,dividedinto3～4aliquots.Feverabateswithin48hours.Totalcourse:10～14days.Sideeffects:suppressionofbonemarrowandaplasticanemia.Prevention

⒈Exterminatingthesourceofinfection.

⒉Reducingandcontrollingthevectors.

⒊Individualprotection:Avoidingcontactwithmites:thebestmethod.Cysticercosis

（囊尾蚴病）

Ⅰ

DefinitionandintroductionOneofparasiticdiseases.CausedbytheinfectionwiththetissuelarvaeofTaeniasolium.AcquiredbyingestionofTaeniasoliumeggsincontaminatedfoods.Humans:definitehostandintermediatehost.

DefinitionandIntroductionHumaninfectedwithTaeniasoliumintwoforms:intestinalTaeniasoliumandcysticercosis.Cysticercosishasgreaterclinicalsignificance.Cysticercosis:humantissueinfectionwiththeintermediatecystformsofporktapeworm.

Cysticercuslocatedinthesubcutaneoustissue,muscle,brain.EtiologyandPathogenesis①Taeniasoliumeggspassedoutfrompatients.

②Eggstakeninbythefecal-oralroute.

③Eggsdigestedbygastricjuicetoliberateoncosphere.

④Oncospherepenetratestheintestinalwallintobloodcirculation.

⑤Locatedinsubcutaneoustissue,muscle,brain.

⑥Scolexappearsanddevelopsintocysticercus.EtiologyandPathogenesis

Cysticercus:●Bladder-like,fluid-filledcyst.●Containinganinvaginatedscolex.●Surroundedbyfibrouscapsule.●Multiple,0.5～2cminsize.EtiologyandPathogenesisCysticercus:●Locationinsubcutaneoustissueandskeletalmuscletoproduceminimal,ifany,symptoms;●Locationinbraintohaveseriouseffects;●Locationinsubstantialtobeabletooccupythespacetoproducetherelevantsign;●Locationinventriculitoproducecysticercusracemosus.Epidemiology●Geographicdistribution:

LatinAmerica,EastEurope,southeastAsia,Africa.

●Sourceofinfection:patient.

●Transmission:fecal-oralroute.●Susceptibility:universal.ClinicalManifestation●Dependon2factors:

①Thelocationandnumberofinfectingcysts;②Iftheinflammationexists.●Braincysticercosis:foundin60～92%ofthetotalcases.●Subcutaneousnodule:foundin2/3ofthetotalcases.ClinicalManifestation⒈Braincysticercosis

Theincubationperiod:within5years.①Cerebralcysticercosis●Epilepsy:

Causedbycysticercilocatedinthecortexneartothemotorium.Alwaysthefirstandtheonlysymptom.ClinicalManifestation●Epilepsy:▲Multifocalandunstableseizure.

▲2/3ofthegrandmalbeginwithalocalspasm.

▲Petitmalincludessensoryandmotorialobstruction.ClinicalManifestation●Neurosis:▲Maybetheonlymanifestationinpatientswithcryptogeniccysticercosis.▲Intracranialhypertensionsymptoms:

vomiting,headache,visualdisturbances.

ClinicalManifestation②Ventricularcysticercosis●10％ofbraincysticercosis.●CausedbyacuteobstructionofCSFcirculation.●Manifestasthevalvesyndrome(Brun'ssyndrome)withintermittentpositionalsevereheadache,vomiting,shock.ClinicalManifestation

③Subarachnoidcysticercosis

●10％ofbraincysticercosis.●Chronic,intermittentmeningitis.●3/4haveincreasedintracranialpressure.

④MixedformMoreseriousneuropsychicsymptoms.ClinicalManifestation

⒉Ocularcysticercosis

●1.8％ofpatientswithcysticercosis.●Singleeyeinvolved.●Eyepain,decreasingvision,retinaldetachment.ClinicalManifestation

⒊Subcutaneousormusclecysticercosis

●2/3ofthepatientshavenodules.●Numberofnodules:1～1000.●Morefrequentlyfeltonbodyandhead.●GenerallynosymptomsDiagnosis●Definitivediagnosis:biopsyoftissuecyst.●Clinicaldiagnosis:

☆Historyofresidenceinanendemicarea;