二成節(jié)mature生殖器成熟

Cestoda(tapeworm扁平Flat,雌雄同體hermaphroditic,帶狀、分節(jié)ribbon-likewithsegments,假葉目11成蟲(chóng)頭節(jié)Scolex幼節(jié)immature

成節(jié)mature: 成 ,蟲(chóng) ♀♂同體無(wú)體腔,無(wú)消化 吸槽suckinggroove小鉤體壁、實(shí)質(zhì)組織中含石灰小/ /幼蟲(chóng)（Metacestode中絳期 棘球蚴hydatidcyst裂頭蚴蟲(chóng)1(圓葉目期卵→六鉤蚴→似囊尾蚴→成2、需要一個(gè)中間宿主(圓葉目六鉤蚴→囊尾蚴→成六鉤蚴→棘球蚴→成3、需要二個(gè)中間宿主(假葉目卵→鉤毛蚴→原尾蚴→裂頭蚴→成 第一中間宿 第二中間宿

鏈狀帶絳Taenia豬帶絳蟲(chóng) 絳蟲(chóng)、有鉤絳 推測(cè)我國(guó)約染100萬(wàn) 當(dāng)前我國(guó)帶絳蟲(chóng)流行情況散發(fā)病例見(jiàn) 各地，遍 27個(gè)省、市均有病例的發(fā)生和不同程度的地方性流行，其中東北、華北、西北和西南的某些地區(qū)為高發(fā)區(qū)。 片是華北地區(qū)；第三片是西北地區(qū)；第是山東、及的皖北和的襄陽(yáng)地區(qū)；第五片是云南、、、廣西、海南。 9 率由不足1%到15.2% 我國(guó)囊蟲(chóng)病情況幼成孕成幼成孕成蟲(chóng)：乳白色、帶狀形1成頭頭頸頸鏈體鏈體

鏈體幼節(jié)uterinebranchesimmatureproglottid(3)7～13uterine蟲(chóng) 胚膜六鉤darkbrown,radiallystriatedembryophore,

囊尾

囊尾LifeIngestedIngestedbyIngestedby GravidGravidproglottidsoreggsescapefromuterus,throughtheRupturewallPenetratethroughtheintestinalwallintoveinandcarriedthroughoutthePenetratethroughtheintestinalwallintoveinandcarriedthroughoutthebody,inmusclesBladderLife

六鉤

囊尾中間宿成 孕節(jié)(卵 (小腸 糞

六鉤統(tǒng)2－3月人食入含豬囊尾蚴 Measly

至－身循 體環(huán)天各處豬囊豬囊特點(diǎn)小腸、期為豬囊尾蚴（食入了“豆豬肉”“米”measlyporks。不存在保蟲(chóng)宿主生在皮下、肌肉、腦、眼等。期為蟲(chóng)卵（或孕節(jié)），在內(nèi)蟲(chóng)卵即有性。3、囊尾蚴可活數(shù)年，成蟲(chóng)活25年以上 Measly成蟲(chóng)致?。簥Z取營(yíng)養(yǎng)、機(jī)械消化道digestive全身性精神神經(jīng)癥狀mental有時(shí)可并發(fā)腸梗阻intestinal一 1條、 19 囊尾蚴致病囊蟲(chóng)病Cysticercosis的危害 絳蟲(chóng)大國(guó)外報(bào)告囊蟲(chóng)病450例中，21.6%有腸絳蟲(chóng)病史國(guó)內(nèi)則為而豬帶絳蟲(chóng)患者有2.3%～25%同時(shí)并發(fā)囊蟲(chóng)病 期愈長(zhǎng)，自 性愈大 方式有三infectiveways自體 internalauto-自體 externalauto-異 1、皮下及肌肉囊尾蚴subcutaneousmuscletissue nodular圓形或橢圓形ovalsize，與皮下組織無(wú)粘連adherence，無(wú)壓痛notenderness。 2、腦囊尾蚴病腦囊蟲(chóng)病是了豬絳蟲(chóng)的蚴蟲(chóng)并侵入腦組織內(nèi)所致的一種性疾病。其較高，約占囊蟲(chóng)病的地區(qū)，長(zhǎng)江以南地區(qū)較低 1、腦實(shí)質(zhì)型：最常見(jiàn)，以癲癇發(fā)作為主，多數(shù)為2、腦膜型多3、腦epilepticseizureshighcerebral精神癥狀mentalsymptoms 3ocular以眼球深部玻璃體（51.6%)HE網(wǎng)膜（37.1％） 豬帶絳蟲(chóng)?。和该髂z紙粘貼法查蟲(chóng)檢獲成蟲(chóng)孕節(jié)typicalgravid囊尾蚴?。?）皮下結(jié)節(jié)——surgicalremove2）眼——眼底鏡funduscopy3）腦——CT、免疫 ：IHA、ELISA、 geneWS379-2012帶絳蟲(chóng)病流行情況world我國(guó):27省流行新流行區(qū)在擴(kuò)大城鄉(xiāng)患病在縮小（聚餐dine兒童患病在上升(烤肉串高于女 2 途徑方式：食 煮熟uncooked的含囊尾蚴——致豬帶絳3、豬的飼養(yǎng)方法不當(dāng)rearof4、不良的飲 dietandPreventionand治驅(qū)PumpkinseedsAreca溫水坐浴hipbathin 查吡喹酮 ,阿苯達(dá) 節(jié)出滅囊尾 住院治 出吡喹酮（同時(shí)用激素：預(yù)防腦水腫cerebral阿苯達(dá)唑Albendazole.吡喹手術(shù)摘除囊蟲(chóng)surgicalremoveofbladder 治療間隙1～2

不吃生或半 healthy肉內(nèi)囊蟲(chóng)在50℃經(jīng)5加強(qiáng)肉類檢查InspectionofInspectionofpigsraisedin5.改變不良的生活方個(gè)人衛(wèi) al飲 dieteticCaseAtwentysixyearoldmanpresentingwithblurringofvisionintherighteyefortendayswasreferredforMRIofthebrainbyageneralhypertension,diabetesorneurologicaldeficit.RoutineMRIofthebrainon1.5Teslascanner(MagnetomSymphony: )wasnormal.with4mmtablefeed)revealedretinal entwithsuspicionofatinylesioninthepostero-lateralquadrantoftherighteyeball. Awell-defined,thinwalledcystwasobservedalongthepostero-lateralwalloftherightorbit.Itmeasured0.6x0.5cminsize.AtinyeccentrichypointensespeckwasseeninitsuggestiveofAdiagnosisofintraocularcysticercosiswithretinal entwasmade.Thepatientunderwentsurgeryandthecystwassuckedout.Itwasintravitrealinlocationwithinflammationinthesurroundingtissues.Thepatientwasasymptomaticaftersurgery. 囊蟲(chóng)病病例分析

肥胖帶絳Taenia 豬帶絳蟲(chóng)與牛帶絳蟲(chóng)的 節(jié) 700~1000 1000~2000較薄，略透 較厚，不透 每側(cè)7~13支，樹(shù)根 側(cè)15~30支，兩叉囊尾 可寄 一般不寄

生活史Life

60～70牛成 孕

牛六鉤

蟲(chóng)卵人每天可排出6～12節(jié) 口8～10特點(diǎn)：1）中間宿主——牛孕節(jié)蠕動(dòng)性強(qiáng)strongly成 長(zhǎng)longlife

checkgravid詢問(wèn)病史孕節(jié)主動(dòng)逸 tendencytocrawlfromthe檢查蟲(chóng) 畜牧區(qū)pasturingarea。傳染源 和帶蟲(chóng)者 食用牛治療：驅(qū)蟲(chóng)同豬帶絳蟲(chóng)chemotherapy注意飲食衛(wèi)生dieteticcustom，inspectionofmeatpreventionof生生食豬AveryrarecaseAn18-year-oldvillagergirlreportedtotheemergencydepartmentofourhospitalwithahistoryofrecurrentvomitingandabdominalpainofonedayduration.Thepatientgavehistoryoflossofappetiteandnauseaofthesameduration.Therewasnopasthistoryofsimilarattacks,butthepatientwasaroutinebeefeater.Physicalexaminationofthepatientwasnormalexceptmildtendernessintheepigastricregion.Mildtachycardiawasnoted,withnormalbloodpressure.Laboratoryinvestigationsrevealedahemoglobinof9g/dl,aleucocytecountof12300/μlandaDLCshowinganeosinophilcountofX-rayoftheabdomenandabdominalultrasonographywasnormal.Thepatientwasdiagnosisofintestinalascariasis(verycommoninthispartofworld)andputonNPO,I.V.-fluidsandRylestubesuction.Onthenextday,thenasogastrictubegotblockedandwassubsequentlyremoved.Onremoval,theheadendofatapewormwhichwasretrievedthroughthenosewasentangledtothelowerendofthetube.11亞洲帶絳 (亞洲牛肉絳Taeniasaginate/Asian分布：亞洲東部 、韓國(guó) 、菲律賓 、我國(guó)部分地區(qū)等都勻米秀鄉(xiāng) 成蟲(chóng):似牛帶絳蟲(chóng)寄生 幼蟲(chóng):似豬帶絳蟲(chóng)寄生豬等動(dòng)物,多見(jiàn)肝內(nèi)(有小鉤生食動(dòng)物 (豬.鹿. .猴.野豬Life幼蟲(chóng)主要寄生于中絳期發(fā)育快,后16天可發(fā)現(xiàn)囊尾蚴29天發(fā)育到期。生存期短（71~97天）。30天后開(kāi)始分終末宿主為人、中間宿主主要是豬，其次是野豬、犢牛、和猴。 “梭

LearningAfterstudyingthischapterthestudentshouldbeabledescribethemajorcharacteristicsoflifecycleillustratethecysticercosis,infectivewaystohumanpathogenesisofdemonstratesthemeasurementsofpreventionand describethemajormorphologicaldifferencesofgravidproglottidsofT.soliumandTsaginata.illustratethemajorcharacteristicsoflifecycleofTanditsExplaintheepidemicfactorsof 細(xì)粒棘球絳Echinococcus又名包生絳蟲(chóng)成蟲(chóng)寄生于犬、狼等食肉動(dòng)物共患的棘球蚴病,又稱包蟲(chóng)病hydatidosis) Itisamajorhygieneprobleminthe本病世界性分布，多見(jiàn)于畜牧業(yè)，影共衛(wèi)生問(wèn)題。Hygieneproblemintheworld我國(guó)為高發(fā)區(qū) 以囊性棘球蚴為主 理推 約38萬(wàn) 理 我國(guó)包蟲(chóng)病的態(tài)勢(shì)在我國(guó)有囊型和泡型包蟲(chóng)病的流行，其中泡型包蟲(chóng)病十年病死率高達(dá)90%，被稱為“蟲(chóng)癌”。包蟲(chóng)病病程長(zhǎng)，治療費(fèi)用較高，給患者及其家庭帶來(lái)極大的痛苦和沉重的經(jīng)濟(jì)負(fù)擔(dān)，是西部農(nóng)牧區(qū)群眾因病致貧、因病返貧的主要原因之一。 E.granulosusoccurspracticallyworldwide,andmorefrequentlyinrural,grazingareaswheredogsingestorgansfrominfectedanimals.

包蟲(chóng)病被列為重大傳染病免費(fèi) 防治包蟲(chóng)病行動(dòng)計(jì)劃（2010–2015年 1、成長(zhǎng)2-

幼成孕蟲(chóng)卵egg：形態(tài)與帶絳蟲(chóng)卵相棘球hydatid假囊pseudo真囊壁角皮cuticlegerminallayerbroodcapsule）子囊daughtercyst囊砂（hydatidsand)

肝包hydatid（蚴棘球蚴囊壁切Brood

六鉤人

棘球肝、中間宿入中間宿成 孕節(jié)(卵犬屬動(dòng)物小

羊、駱

六鉤穿腸成半年左

共需犬、狼呑

約3～5成直徑棘球 人吞食蟲(chóng)卵的途徑：waysofentryto蟲(chóng)卵污染食物egg與狗接觸closely以及皮毛加furproduction22致病累及部位involved69.9involved19.3%involved其他部位Others:腹腔abdominal ,脾spleen腎kidney,骨bone,腦brainandsoon.22棘球蚴生長(zhǎng)緩慢slowgrowth，需5-20年達(dá)到較 1、局 和刺激癥狀Mechanical2 和過(guò)敏癥狀Toxicandanaphylatic3、繼 Secondaryinfectionandhydatid 包蟲(chóng) 標(biāo)準(zhǔn)(WS257-影 免疫 ImmunologicCasoniskin020/12020/12注意：嚴(yán)格控制穿流不但使人發(fā)病，還造成極大的經(jīng)濟(jì)損失 傳染源：能排出孕節(jié)的犬、dogdomesticherbivorescycle。 流行因素蟲(chóng)卵污染外界環(huán)境，蟲(chóng)卵抵抗力強(qiáng)contaminatedand of人與家畜和環(huán)境的密Closewithinfecteddogsanddomestic病畜內(nèi)臟喂狗或亂Dogsfeedonthevisceraofinfectedhosts防 生宣傳教 治療以手術(shù)治療為主Surgical

內(nèi)囊摘除藥物治療療效不佳，albendazole首選甲苯咪唑孕婦慎

Casereport:Primaryhydatidcystofmuscle-AraresiteAfiftyyearladypresentedwithalargepainlessswellinginthethighforfourmonths.Therewasnohistoryoftrauma,nontendercysticswellingoccupyingnearlythewholeofthemedialaspectofthethighwithfixityofthemuscles.Onbloodexamination,thetotalleucocytecountwas7500cellsUL-1(2%eosinophils).ThepatientwassentforanMRIfortheexactlocalizationandextentofthemassandtoruleoutanyinvolvementofthebone.AroutineMRIexamination(1.5Tsymphony, includedSTIRsequenceincoronalplaneandGRET2WandSET1WsequencesinaxialplaneThestudyrevealedalargemultiloculatedcysticlesioninthemedialcompartmentofthethighmainlyoccupyingtheadductormagnusmuscleItmeasured28.0x11.5x12.0cminsize.MultiplesmallerdaughtercystsandafreefloatingmembranewereseeninitAdiagnosisofhydatidcystwasmade.Inferiorlyitwasencasingthesciaticnerve。UltrasoundguidedFNACwasdonewhichandpinkishhomogenouschitinousmaterialwithevidenceofsuperaddedinfection。Ultrasoundoftheabdomenandx-raychestwerenormal.大收細(xì)針吸取組織細(xì)大收

多房棘球絳蟲(chóng)Echinococcus 成蟲(chóng)主要寄生在狐等幼蟲(chóng)期寄生在嚙齒類、食 變Causingfataldisease亦稱：泡型多房性包蟲(chóng)病hedatid 致病特1、泡球蚴為外生 病灶在肝臟，肝腫大96%，觸診腫塊3、癥狀常似肝癌，“第 ”；病程可持續(xù)多4、晚期因肝功能損害、衰竭致 常5、門(mén)靜脈高壓并發(fā)消化道 泡球蚴病主要流行于北半球的高寒地區(qū)，我國(guó)以青海、 、 、 等地有流行。 目前的治療藥物：阿苯噠唑甲苯咪唑（大劑量吡喹早期手術(shù)治 囊性和泡性棘球曼氏迭宮絳Spirometra假葉目絳幼蟲(chóng)——裂頭引起曼氏裂頭蚴（sparganosis 蟲(chóng)曼氏迭宮絳蟲(chóng)裂頭細(xì)長(zhǎng)，3000.7mm，體不分節(jié)生活

入成 鉤球小 糞犬、貓或人呑轉(zhuǎn)續(xù)宿被蛇捕食

宿一蚤主中蚤間第犬、貓或人呑

宿二主中間

蛙體 spargan020/12/1生活史特點(diǎn)第一中間宿主：劍水蚤第二中間宿主：蛙 轉(zhuǎn)續(xù)宿主：鳥(niǎo)、獸終宿主：貓、人可以作為第二中間宿主、轉(zhuǎn)續(xù)宿主或終宿 致病成蟲(chóng) 成蟲(chóng)偶然寄裂頭蚴眼eyeform(34.1%),多累及單側(cè)眼瞼或眼球皮膚skinform(35.53%),口腔頜面部faceform(16.39腦brainform12.44%)以額葉、頂葉多見(jiàn)內(nèi)臟internalorganform(1.56%)增殖型proliferative病史糞便檢查Stool組織檢查影像檢CTX-免疫學(xué)檢測(cè)ImmunogicWS438-2013《裂頭蚴病 》 衛(wèi)生行業(yè)標(biāo) 流行分布：成蟲(chóng)較罕見(jiàn)，裂頭蚴病

個(gè)省:成

途徑和方1、局部敷貼生蛙肉Bypoulticingthewoundwith2、吞食生的、未 蛙、蛇肉Ingestionofinfectedfleshofamphibia,reptiles, 進(jìn)入Ingestionofinfectedcyclops 防不用蛙肉、皮貼患不生食 肉不飲生.成蟲(chóng)以吡喹酮 )驅(qū)5.裂頭蚴以手術(shù)(Surgicalremoval)為主要措 AbdominalSparganosisPresentingasanAbscesswithFistulousCommunicationtotheBowelA20-year-oldmanwasadmittedtoourinstitutionwitha3-dayhistoryoffeverandabdominalpain.Abdominalsonographyshowedabicameralair-containingabscess y7-cmair-containingbicameralabscess withadjacentmesentericfatinfiltrationwasvisualizedinthelower Asmall-bowelfollow-throughperformedonthehospitaldayrevealedasubtlemasseffectwithmucosalfoldthickeningoftheadjacentilealloopandnofistuloustract.asymptomaticandwasdischargedontheseventhdayafter鋇admissionHewasreadmittedwithasuddenfeverand影造examinationshowedleukocytosiswithouteosinophilia,影abdomencontainingahigh-attenuationmaterialThismaterialwasthoughttoberesidualbariumfromtheAserologicenzyme-linkedimmunosorbentassay(ELISA)forsparganumwaspositive,asegmentalresectionoftheileumwasperformed,andduringsurgeryasmallperforationwasfoundintheileum.Thepatient'spostoperativecoursewasuneventful微小膜殼絳蟲(chóng)HymenolepisAdult:small,theminutescolexisrhomboidal,3testesinthematureproglottids spherical,twopolarthickenings,fromwhichariseslongpolarfilaments,containsa

Ingestedbyor

PenetrateintotheVilliofPenetrateintotheVillioftheintestine~4~byman15days

ticercoidSITEOFINFECTIONINLOCATIONOFEGGSINHUMANSlungs,visceramanynoneincanids;hydatidcyststhroughoutbodymainlynoneincanids;humanssmallintestine,throughoutbodysmalladultsinsmallthroughoutbodyswine;Hymenolepisrodents;smallarthropodsLearningAfterstudyingthischapterthestudentshouldbeable1.describethestructureandpathogenesisofthe