人體寄生蟲學(xué)課件：Medical Flagellates鞭 毛 蟲

1、鞭 毛 蟲FLAGELLATEContents1. Leishmania donovani 杜氏利什曼原蟲2. Trichomonas vaginalis 陰道毛滴蟲3. Giardia lamblia 藍(lán)氏賈第鞭毛蟲 Parasite in bone marrowCase I黑熱病.f4vBone marrow smearLeishmania donovani杜氏利什曼原蟲Three types:1. Visceral leishmaniasis: VL,also call kala-azar, pathogen is Leishmania donovani.2. Mucocutaneous

2、 leishmaniasis: MCL, pathogen is Leishmania braziliensis.3. Cutaneous leishmaniasis: CL, Pathogen is Leishmania tropica and Leishmania mexicana.I MorphologyThere are two stages in life cycle: Amastigote and Promastigote.Amastigote Promastigote1. Amastigote (無鞭毛體） L.D.body （利杜體）Ovoid 2-3 um ;one nucl

3、eus and one kinetoplast;rhizoplast;basal body kinetoplast basal body rhizoplast nucleusAmastigote in macrophagePromastigote (前鞭毛體） 10-20 x 1.5um fusiform in shape one nucleus one anterior flagellumflagellumnucleusPromastigote in the digestive tract of sandflyPromastigote in the cultureThe movement o

4、f promastigoteII Life cycleVectorsPhlebotomine SandfliesAmastigotePromastigote Key notes1 infective stage: 2 mode of infection: 3 site of habitation: 4 pathogenic stage: 5 diagnostic stage: 6 reservoir host: 7 vector: Key notes1 infective stage: promastigotes2 mode of infection: bitten by sandfly3 s

5、ite of habitation: macrophages 4 pathogenic stage: amastigotes5 diagnostic stage: amastigotes 6 reservoir host: dogs7 vector: sandflyThe promastigotes invade the macrophages.The amastigotes multiply in macrophages in the spleen,liver,lymph nodes, and bone marrow. III PathogensisCellular proliferatio

6、n,destroy macrophages Enlargement of spleen,liver,lymph nodes.Immune hemolysis 1. Visceral leishmaniasisfever: long time, irregular; two high peak enlargement of spleen,liver,lymph nodes (Cellular proliferation) Anemia (all blood cells decreased) caused by splenamegalyVisceral leishmaniasisMassive h

7、ypertrophy of spleen and liver.The ratio of albumin(清蛋白） to globulin （球蛋白） is inverted.(Destroy liver function, albumin ,globulin)splenomegalydistended abdomenemaciation, ascites2. Lymph glands leishmaniasisMajor in lymph gland nodeEnlargerment of lumph node all over the bodyPeanut or chestnut in si

8、zeNo obvious acheCase II女患,16歲。半年來自覺疲倦,食欲不振,間有發(fā)熱,日漸消瘦。近一月寒戰(zhàn)、高熱、盜汗、頭暈、極度乏力、全身疼痛,反復(fù)鼻衄,左耳后及頸部出現(xiàn)腫塊。查體:體溫41,脈搏128次/分,表情淡漠,消瘦,重度貧血貌。牙齦出血,左耳后、左頸部淋巴結(jié)腫大,融集成團(tuán)塊,約雞蛋大,左腋窩、腹股溝淋巴結(jié)蠶豆大。肝肋下2cm,脾肋下6cm,質(zhì)硬。Occurs 1-2 years after treatment Pigment in the skin followed by nodule formation 55% happened with visceral leish

9、maniasis35%happened many years after visceral leishmaniasis10% only have dermal leishmaniasis 3. Dermal leishmaniasis Dermal leishmaniasisCutaneous leishmaniasis Diagnosis1.Pathogenic test1) Puncturing testBone marrow puncturing test :80-90%, most often used.Lymph nodes/liver puncturing : 46-87%,als

10、o used.Spleen puncturing : rarely used,90-99%.2）CultivateNNN cultivator, 2225 one week.Animal test -one monthLiver slide3) Biopsy用消毒針頭刺破皮膚結(jié)節(jié)，手術(shù)刀刮取少許組織或組織液作涂片，染色，鏡檢4）Immunology test Antigen test : McAb-AST 陽性率達(dá)97.03%，診斷現(xiàn)行感染，考核療效。Antibody test : ELISA,IHA,CIE,局限性Intradermal test: 流行病學(xué)調(diào)查 5）Molecular te

11、st PCR, Dip-stick 陽性率達(dá)95.5%EpidemiologyLeishmaniasis is prevalent world wide: ranging from south east Asia, Indo-Pakistan, Mediterranean, north and central Africa, and south and central America.Type1. Human source: 又稱為平原型,青壯年多見2. Dog source: 又稱為山丘型，兒童多見3. Natural source：又稱為荒漠型，嬰幼兒多見Treatment and Pre

12、vention葡萄糖酸銻鈉Antimony sodium gluconate戊脘脒（pentamidine）或二脒替（stilbamidine）Vector control：溴氰菊酯滯留噴灑滅蛉；采用紗窗、紗門、蚊帳、滅蛉器、驅(qū)避劑等Reservoir control: 定期查犬、早發(fā)現(xiàn)、早捕殺VaccinationControl一起由污染公共給水引起的寄生蟲病大爆發(fā)1985年11月1986年1月發(fā)生在馬塞諸塞州皮茨菲爾德市的一起大規(guī)模引用水污染引起的腹瀉。表現(xiàn)為腹瀉,脹氣,乏力,腹痛,納差,浮腫,惡心,體重下降,嘔吐,發(fā)熱和血痢。對(duì)139戶病家調(diào)查發(fā)現(xiàn),有147人經(jīng)實(shí)驗(yàn)室證實(shí)為賈第蟲病患者(

13、病例組)。其中74%的患者系在家中飲水的。藍(lán)氏賈第鞭毛蟲Giardia lambliaIntestinal flagellateGiardiasis Diarrhea 1. MorphologyTwo stages: Trophozoite and cyst1.1 Trophozoite 1. pear-shaped 2. 5-15um x 2-4um 3. four pairs of flagella 4. two axostyle； median body 5. a sucking disk with 2 oval nuclei Trophozoite movementTrophozoit

14、e1.2 Cystoval in shape8-14x7-10umthick cyst wall 2-4 nuclei axostyles and median body CystOval in shapeThick cyst wallThe immature Cysts usually have two nuclei2. Life cycleinhabits the duodenum and upper ileumGiardiasis G. lamblia inhabits the duodenum and upper ileumThey damage the mucosa and caus

15、e atrophy of the villusKey notes1. Definite host: human2. Two stages: Trophozoite and cyst3. Inhabit place: small intestine4. Simple life cycle: cyst-trophozoite-cyst 5. Infective stage: cyst6. Infective mode: Ingested the mature cysts in contaminated water and food3. Pathogenesis(1) 蟲體方面: 變異性表面蛋白（v

16、ariant surface proteins, VSPs）逃避宿主免疫。(2) 宿主方面 (3) 蟲體-宿主交互作用 二糖酶缺乏 Changes the architecture of intestinal villusSymptomsOnly few has symptomsincubation period：12-22dAcute stage: Vomit,Anorexia (食欲減退）;低熱；寒戰(zhàn)；Flatulence (胃腸氣漲);Cramp abdominal pain（痙攣性疼痛）;Fever;Water like stools with an offensive odor（突發(fā)

17、性惡臭水樣瀉)Chronic giardiasis:間歇性惡臭軟便，伴腹脹，痙攣性疼痛，厭食，惡心，便秘，周期性稀便，數(shù)年不愈。Cholecystitis（膽囊炎） or cholangitisDiagnosis3.1 Parasitological examination (1) Feces examinationWater like feces: Trophozoites Formed feces: cysts, 3 timesMethod:1.Direct smear with normal saline: Detect trophozoite in uniformed stools o

18、r duodenal aspiration2.Direct smear with iodine-stain: Detect cyst in formed stools (2) Duodenal fluid or bile examinationa) String test or Entero test (腸檢膠囊法)b) Biopsy of intestine tissuec) Duodenal aspiration (十二指腸引流法)4. EpidemiologyTransmission sourcePersons whose feces contain cysts Transmission

19、 routeDrinking contaminated water Eating contaminated Food Giardiasis is more common in travelers, Immunodeficiency persons and buggers 5. Prevention and control5.1 Treat the patients and carriersMetronidazole (滅滴靈） Tinidazole(硝砜咪唑） 5.2 Treatment of the drink waterSuspect water should boiled or adeq

20、uately Filtered to remove the infective cysts before Drinking. Case III患者，女，25歲，近半年自感：白帶增多，外陰瘙癢，尿頻、尿急、尿痛，服用抗生素后反復(fù)發(fā)作。檢查見：陰道粘黏膜充血，散在出血斑點(diǎn)，“草莓樣”宮頸后穹隆多量白帶，呈灰黃色、黃白色稀薄液體或黃綠色膿性分泌物，常呈泡沫狀。分泌物涂片Trophozoites mainly parasitize in the vagina of women, and urethra, prostate, testis of men cause Trichomonas vaginit

21、is or Trichomonas urethritis.Trichomonas vaginalis陰道毛滴蟲1. Morphologyovoid or pyriform in shape;5-15um;4 anterior flagellae and 1 posterior flagellum one nucleus and the axostyle The motility is jerky and non-directional. Only trophozoites in life cycle, no cyst stageA sexually transmitted diseasesex

22、ual intercourse Women: vaginaMen: urethra or prostate, testes, epididymisThe infective stage is trophozoite2. Pathogenesis Mainly affecting 16-to-35-year old women.Reason: PH in vaginal change from 4 to 7. Clinical manifestations: Women: itching or burning sensation in pudenda and increased leucorrhoea. Vaginal secretions : sallow and bubbly with peculiar smell. Men: cause dysuria（排尿困難）, nocturia（夜尿癥）, prostate（前列腺 enlargement and tenderness and epididymitis （附睪炎）3. DiagnosisFinding trophozoitesIn women: virginal dischargesIn the male: urethral discharges , pro