1、NemotodaCestoda TrematodaMedical helminth.Liver Fluke.VocabularyDioecism daii:sizm雌雄异体雌雄异体Hermaphroditic h:mfrditik雌雄同体雌雄同体Miracidium mairsidim毛蚴毛蚴Sporocyst sp:rsist胞蚴胞蚴Encyted metacercaria mets:kri囊蚴囊蚴Rediae 雷蚴雷蚴Cercariae 尾蚴尾蚴Encyst-excyst 成囊成囊-脱囊脱囊.Liver Fluke.VocabularyBile 胆汁胆汁 Clonorchiasis klu
2、n:kaisis 肝吸虫病肝吸虫病 Intrahepatic bile duct 肝胆管肝胆管Pancreatic 胰腺的胰腺的Gall bladder 胆囊胆囊Faeces fi:si:z 粪便粪便Diarrhoea da r腹泻腹泻 putrescentpju:tresnt 坏死坏死.Liver Fluke.VocabularyHepatocirrhosis heptusirusis 肝硬化肝硬化 Atrophy trfi萎缩萎缩 ascites saiti:z腹水腹水.Trematodes,FlukesGeneral characters.MophologyGeneral charact
3、ers Leave-shaped,flat Hermaphroditic(except Schistosome)have mouth but no anus With oral sucker and ventral sucker Most flukes egg has a operculum.Adult worms Adult worms eggseggscercariacercariaRediaeSporocystMiracidia encysted encysted metacercariametacercariaLife cycleDefinitive hostSecond interm
4、ediate hostFirst intermediate hostGeneral characters Mophology.metagenesisasexual asexual generationgenerationSexual Sexual generationgenerationGeneral characters MophologyLife cycle.More than 30 species of flukes parasitic in human body,all belong to Phylum Platyminthes(扁形动物门）Class Trematoda（吸虫纲）Or
5、der Digenea（复殖目）General characters species of flukes.Flukes endemic in chinaFlukes endemic in china Clonorchis sinensis Clonorchis sinensis 华支睾吸虫华支睾吸虫 Paragonimus westermaniParagonimus westermani 卫氏并殖吸虫卫氏并殖吸虫 Schistosoma japonicumSchistosoma japonicum 日本血吸虫日本血吸虫 Fasciolopsis buskiFasciolopsis buski
6、布氏姜片吸虫布氏姜片吸虫 Pagumogonimus skrjabiniPagumogonimus skrjabini 斯氏狸殖吸虫斯氏狸殖吸虫General characters species of flukes.华支睾吸虫华支睾吸虫(Clonorchis sinensis)introductionintroduction肝吸虫肝吸虫(liver fluke）causing ClonorchiasisFirstly found in a Indian Chineses bile duct in 1874.Morphology Life cycle Pathogenesis Diagnosi
7、s Prevalence Prophylaxis肝吸虫肝吸虫(liver fluke）华支睾吸虫华支睾吸虫(Clonorchis sinensis).Liver flukeLiver flukeMorphologyMorphology10-253-5mmOral suckerVentral suckerSpermary睾丸睾丸 Uterus 子宫子宫Intestine branch1.Adult worm1.Adult wormGullet 咽咽Overy 卵巢卵巢.1.Adult worm1.Adult wormLiver flukeLiver flukemorphologymorpholo
8、gy.Sesame like,broadly ovoidLight yellowish-brown 2.egg 2.egg 2917um，sizesizecolorcolorshapeshapeshellshellContaining Containing With a distinct convex operculuma miracidium inside the egg Liver flukeLiver flukemorphologymorphology.2.egg2.egg卵盖operculum肩峰shoulder卵壳 shell毛蚴 miracidium疣状突起疣状突起 tiny kn
9、obLiver flukeLiver flukemorphologymorphologysizesizecolorcolorshapeshapeshellshellContaining Containing .蠕虫卵中我最小，形似芝麻棕黄色。上有盖来下有疣，肩峰明显内毛蚴。2.egg2.eggLiver flukeLiver flukemorphologymorphology.MiracidiumLiver flukeLiver flukemorphologymorphology3.Other stage3.Other stage.Liver flukeLiver flukemorpholog
10、ymorphologyother stagesother stages sporocyst3.Other stage3.Other stage.rediaeLiver flukeLiver flukemorphologymorphologyother stagesother stages Generation cellUnmature Cercariae 3.Other stage3.Other stage.CercariaeLiver flukeLiver flukemorphologymorphologyother stagesother stages 3.Other stage3.Oth
11、er stage.Liver flukeLiver flukemorphologymorphologyother stagesother stages Fresh water fishEncysted metacercariae in fish musculature3.Other stage3.Other stage.Liver fluke Liver fluke life cyclelife cycle First intermidiate hostSecond intermidiate hostDefinitive hostshrimpCyprinidaesnail.Liver fluk
12、e Liver fluke life cyclelife cycle Adult wormseggmiracidiumSporacyst rediaecercariaeEncycted mtacercariae.尾蚴雷蚴胞蚴毛蚴 囊蚴猫25-30d鼠21d100d25时，30-40d童虫 成虫 卵Liver fluke Liver fluke life cyclelife cycle .1.host 纹沼螺 长角涵螺 赤豆螺(1)the first intermediate host fresh water snailLiver fluke Liver fluke life cyclelife
13、 cycle .1.host(1)the first intermediate host fresh water snail(2)the second intermediate host fresh water fish(family Cyprinidae鲤科)Liver fluke Liver fluke life cycle life cycle conclusionconclusion .(3)Definitive host human，cat,dog,pig,rat,et al.1.Host(1)the first intermediate host fresh water snail
14、(2)the second intermediate host fresh water fish(family Cyprinidae)Liver fluke Liver fluke life cycle life cycle conclusionconclusion .1.Host2.Infection stage and methodinfection stage-encysted metacercariae infection way-ingestion of raw,under cooked,pickled fish harbouring metacercariae Liver fluk
15、e Liver fluke life cycle life cycle conclusionconclusion .1.Host2.Infection stage and method3.Excrete way in human bodyInmature wormcommon bile ductblood streamabdomen antrum Bile passagesLiver fluke Liver fluke life cycle life cycle conclusionconclusion through.1.Host2.Infection stage and method3.E
16、xcrete way in human body4.Parasiting 4.Parasiting position Adult worms areparasitic in bile ductsLiver fluke Liver fluke life cycle life cycle conclusionconclusion .1.host2.infection stage and method3.passing way in human body4.parasitized position5.leaving body 5.leaving body stage and stage and me
17、thodmethod eggs exit the bile ducteggs exit the bile ductand are excreted in the faecesand are excreted in the faecesLiver fluke Liver fluke life cycle life cycle conclusionconclusion .Pathogenetic stagePathogenetic stagePathogenetic mechenismPathogenetic mechenismSymptomologySymptomologyLiver fluke
18、 Liver fluke pathogenicitypathogenicity .Immature adult wormMature adult wormEggsLiver fluke Liver fluke pathogenicitypathogenicity pathogenetic pathogenetic stagestagePathogenetic Pathogenetic mechanismmechanismSymptomologySymptomology.metablites and mechanical effects causes proliferative and infl
19、ammatory reactions in the biliary epithelium of the bile ducts.Encapsulating fibrosis of the ducts Bile ducts are dilated at the points where the flukes are attached to the inner liningpathogenetic pathogenetic stagestagePathogenetic Pathogenetic mechanismmechanismSymptomologySymptomologyLiver fluke
20、 Liver fluke pathogenicitypathogenicity .chronic infection,hepatic cells near the bile passages become denaturalized and putrescent(坏死)，causing hepatic tissue atrophy(萎缩)apparently.late period,causing hepatocirrhosis(肝硬化)and ascites(腹水).if parasitized by large amount of flukes,bile duct will be obst
21、ructed,bile is blocked and icterus will happen.Liver fluke Liver fluke pathogenicitypathogenicity pathogenetic pathogenetic stagestagePathogenetic Pathogenetic mechanismmechanismSymptomologySymptomology.Other diseases caused Cholecystitis(胆囊炎)，cholangitis(胆管炎)，hepatitis(肝炎)；cholelithiasis(胆石症)pancre
22、atic inflammatory(胰腺炎)cholangiocarcinoma(胆管上皮癌)hepatitic cancer 肝癌；hypogenesis(发育不良)Liver fluke Liver fluke pathogenicitypathogenicity pathogenetic pathogenetic stagestagePathogenetic Pathogenetic mechanismmechanismSymptomologySymptomology.头痛乏力，消化不良；腹痛腹泻，上腹不适；肝区隐痛，常不明显。头乏消肝痛，三腹并不适头乏消肝痛，三腹并不适Liver fl
23、uke Liver fluke pathogenicitypathogenicity pathogenetic pathogenetic stagestagePathogenetic Pathogenetic mechanismmechanismSymptomologySymptomologyHeadache,being tired and dyspepsia,abdominal distress,diarrhoea,midsection being discomfortable,and with minor symptom of ache in liver.with a symptom of
24、 tumefaction in the liver and spleenLiver fluke Liver fluke pathogenicitypathogenicity pathogenetic pathogenetic stagestagePathogenetic Pathogenetic mechanismmechanismSymptomologySymptomology.1.diagnosis of pathogeny 1.diagnosis of pathogeny of feces by（steak feces on a slide,concentration of eggs）o
25、f aspirated bile by duodenal aspiration 胆汁（十二指肠引流）Liver fluke Liver fluke diagnosis diagnosisdemonstration of Eggs by demonstration of Eggs by microscopical examinationmicroscopical examination.2.immunodiagnosis2.immunodiagnosis（for screening patients primarily,and assistance of diagnosis）skin test
26、using extracts of adult liver fluke 皮试 indirect haemagglutination assay(IHA)ELISALiver fluke Liver fluke diagnosis diagnosisDemonstration of antibodies against liver fluke.1.distribution1.distributionall over the world,especially in China,Japan,Korea,Vietnam,and Southest Asia我国我国：内.宁.西.海.新尚无内蒙、宁夏、西藏
27、内蒙、宁夏、西藏青海、新疆青海、新疆高发区：珠江三角洲Liver fluke Liver fluke prevalence prevalence.1.ditribution1.ditribution2.elements relevant to prevalence2.elements relevant to prevalenceIntermidiated hostThe chance of swallowing the encysted metacercariaeThe souce of infectionEggs enterwaterLiver fluke Liver fluke preva
28、lence prevalence.1997年广东省不同鱼种肝吸虫的感染率（%）麦穗鱼 61.22白鲢 56.3白鲩 55.6花鲢 54.6Liver fluke Liver fluke prevalence prevalence.Intermidiated hostThe chance of swallowing the encysted metacercariaeThe souce of infectionEggs enterwaterLiver fluke Liver fluke prophylaxis prophylaxis.Intermidiated hostThe chance of
29、 swallowing the encysted metacercariaeThe souce of infectionEggs enterwaterLiver fluke Liver fluke prophylaxis prophylaxis1.Cure the patients and asymptomatic infected person.Intermidiated hostThe chance of swallowing the encysted metacercariaeEggs enterwaterLiver fluke Liver fluke prophylaxis proph
30、ylaxis1.Cure the patients and asymptomatic infected person.Intermidiated hostThe chance of swallowing the encysted metacercariaeEggs enterwaterLiver fluke Liver fluke prophylaxis prophylaxis1.Cure the patients and asymptomatic infected person2.Deal with feces.Intermidiated hostThe chance of swallowi
31、ng the encysted metacercariaeLiver fluke Liver fluke prophylaxis prophylaxis1.Cure the patients and asymptomatic infected person2.Deal with feces.Intermidiated hostThe chance of swallowing the encysted metacercariaeLiver fluke Liver fluke prophylaxis prophylaxis1.Cure the patients and asymptomatic i
32、nfected person2.Deal with feces.3.Change the habit of eating(uncooked fish)；.Intermidiated hostLiver fluke Liver fluke prophylaxis prophylaxis1.Cure the patients and asymptomatic infected person2.Deal with feces.3.Change the habit of eating(uncooked fish)；.并殖吸虫（Paragonimus)第三节第三节.肺吸虫（lung flukes)概述概
33、述卫氏并殖吸虫（肺型）斯氏狸殖吸虫（皮肤型）.并殖吸虫（Paragonimus)（一）肺吸虫（lung flukes)卫氏并殖吸虫.肺吸虫肺吸虫形态形态 1.1.成虫成虫 长 7-12mm宽 4-6mm厚 3.5-5.肺吸虫肺吸虫形态形态 1.1.成虫成虫体棘游走习性.肺吸虫肺吸虫形态形态 2.2.虫卵虫卵大小颜色形状结构56100um.肺吸虫肺吸虫形态形态 2.2.虫卵虫卵卵壳卵黄细胞卵细胞卵盖56100um大小颜色形状结构.肺吸虫肺吸虫形态形态 3.3.其他其他雷蚴囊蚴尾蚴.肺吸虫肺吸虫生活史生活史 .尾蚴母雷蚴子雷蚴胞蚴毛蚴童虫 成虫 卵 囊蚴肺吸虫肺吸虫生活史生活史 .1.1.宿主宿主
34、2.感染阶段 及方式3.移行途径4.寄生部位5.离体阶段 及方式第一中间宿主 川卷螺肺吸虫肺吸虫生活史生活史 .1.1.宿主宿主2.感染阶段 及方式3.移行途径4.寄生部位5.离体阶段 及方式第一中间宿主 川卷螺第二中间宿主 溪蟹、蝲蛄肺吸虫肺吸虫生活史生活史 .1.1.宿主宿主2.感染阶段 及方式3.移行途径4.寄生部位5.离体阶段 及方式 终宿主 人，肉食性的哺乳动物 （保虫宿主）第一中间宿主 川卷螺第二中间宿主 溪蟹、蝲蛄肺吸虫肺吸虫生活史生活史 .1.宿主2.2.感染阶段感染阶段 及方式及方式3.移行途径4.寄生部位5.离体阶段 及方式感染阶段：囊蚴 感染方式：生食/半生食 溪蟹、蝲蛄
35、 肺吸虫肺吸虫生活史生活史 .1.宿主2.感染阶段 及方式3.3.移行途径移行途径4.寄生部位5.离体阶段 及方式肺吸虫肺吸虫生活史生活史 皮下肠壁腹腔膈肌胸腔肺肺童虫腹壁纵隔心、脑.1.宿主2.感染阶段 及方式3.移行途径4.4.寄生部位寄生部位5.离体阶段 及方式肺吸虫肺吸虫生活史生活史 虫囊.1.宿主2.感染阶段 及方式3.移行途径4.寄生部位5.5.离体阶段离体阶段 及方式及方式肺吸虫肺吸虫生活史生活史 虫卵去向：虫卵去向：虫囊完整时，虫卵沉积于囊内；虫囊与血管相通：引起小血管栓塞；虫囊与淋巴管相通：虫卵沉积于肺 淋巴结；虫囊与支气管相通：虫卵随痰/粪 排出体外。.肺吸虫肺吸虫致病致病
36、 致病阶段致病阶段致病机理致病机理临床表现临床表现.肺吸虫肺吸虫致病致病 致病阶段致病阶段致病机理致病机理临床表现临床表现童虫、成虫.肺吸虫肺吸虫致病致病 致病阶段致病阶段致病机理致病机理临床表现临床表现童虫/成虫的机械性损伤及异物反应。脓肿期囊肿期纤维斑痕期肺型肺吸虫病：.肺吸虫肺吸虫致病致病 致病阶段致病阶段致病机理致病机理临床表现临床表现童虫/成虫的机械性损伤及异物反应。脓肿期囊肿期纤维斑痕期细胞浸润局部出血组织坏死肉芽组织增生并包围虫体，囊内可见大量虫卵和夏科雷登结晶虫体转移或死亡，形成疤痕病理变化X线特征浸润性阴影多房性囊样阴影硬结性或条索性阴影肺型肺吸虫病：.肺吸虫肺吸虫致病致病
37、致病阶段致病阶段致病机理致病机理临床表现临床表现童虫/成虫的机械性损伤及异物反应。肺型肺型肺吸虫病：腹腔型腹腔型：引起广泛的炎症反应和粘连胸腔型胸腔型：胸膜炎，纵隔炎脑型脑型：占位性病变及损伤皮肤型皮肤型：游走性的皮下包块或结节.肺吸虫肺吸虫致病致病 致病阶段致病阶段致病机理致病机理临床表现临床表现轻症轻症：表现为食欲不振、乏力、消 瘦、低热等非特异性症状；重症重症：毒性症状明显，如高热、腹 痛、腹泻等。血象血象：白细胞，嗜酸性粒细胞（20-40%）.1.1.病原检查：病原检查：查虫卵：痰、粪便 组织活检：皮下包块2.2.免疫学诊断：免疫学诊断：皮试：阳性率可达98-100%IHA：阳性滴度在
38、1：20以上；ELISA：阳性率可达90-100%。肺吸虫肺吸虫实验诊断实验诊断 .五、传播与流行流行因素：1、病人和保虫宿主的存在：犬、猫、猪2、中间宿主的存在：第一中间宿营主川卷螺有十多种 第二中间宿主淡水蟹能传播卫氏并殖吸虫者有20余种。3、生吃或半生吃溪蟹、喇蛄或动物肉类（转续宿主）的不良习惯。.六、防治原则（一）防止病从口入，不吃生食，不喝生水，防止囊蚴污染餐具。（二）加强粪便管理，不随地吐痰。（三）治疗病人，病畜，常用药物有吡喹酮、硫双二氯酚）又名别丁）等。.小结 1、肝吸虫卵是肠道寄生虫卵中最小的虫卵之一，镜下呈芝麻状；颜色是棕黄色；卵壳具卵盖；盖上有肩峰；底部有一疣状突起；内容物是一条毛蚴。2、肝吸虫生活史过程中第一中间宿主是淡水螺，第二中间宿主是淡水鱼虾。3、肝吸虫寄生于肝胆管，虫体的机械刺激及分泌物的化学刺激，使肝胆管上皮细胞脱落增生，管壁因结缔组织增生而增厚。.小结 4、病原学诊断：查虫卵，十二指肠引流胆汁进行离心沉淀查虫卵。5、肺吸虫卵较大；椭圆形；金黄色；卵壳表面光滑，厚薄不均，大多有卵盖；内容物是一个卵细胞及十多个卵黄细胞 6、肺吸虫成虫寄生于肺，但有腹腔型、胸腔型、脑型、皮肤型的异位寄生。.问答题：1、肝吸虫病、肺吸虫病的防治应注意哪些环节？2、肝肺吸虫病的临床表现有哪些？.
