1、中國醫科大學附屬盛京醫院感染科中國醫科大學附屬盛京醫院感染科 寄生于人體內臟器（肺部為主）或皮下組織的并殖吸寄生于人體內臟器（肺部為主）或皮下組織的并殖吸蟲所致的一種慢性寄生蟲病蟲所致的一種慢性寄生蟲病 人吞食含有并殖吸蟲活囊蚴的溪蟹或喇蛄而感染人吞食含有并殖吸蟲活囊蚴的溪蟹或喇蛄而感染 臨床表現：衛氏并殖吸蟲引起以肺部病變為主的全身臨床表現：衛氏并殖吸蟲引起以肺部病變為主的全身性疾病，主要表現為咳嗽、咳鐵銹色或爛桃樣痰、咯性疾病，主要表現為咳嗽、咳鐵銹色或爛桃樣痰、咯血等，稱肺吸蟲病。斯氏貍殖吸蟲引起的主要病變是血等，稱肺吸蟲病。斯氏貍殖吸蟲引起的主要病變是游走性皮下包塊和滲出性胸膜炎游走性

2、皮下包塊和滲出性胸膜炎 自然疫源性疾病自然疫源性疾病病原體：衛氏并殖吸蟲和斯氏并殖吸蟲病原體：衛氏并殖吸蟲和斯氏并殖吸蟲衛氏并殖吸蟲衛氏并殖吸蟲：三倍體型蟲體能在體內成熟并：三倍體型蟲體能在體內成熟并產卵，二倍體型不適宜于人體寄生產卵，二倍體型不適宜于人體寄生斯氏并殖吸蟲：蟲體狹長，在人體不能發育為斯氏并殖吸蟲：蟲體狹長，在人體不能發育為成蟲。終宿主為犬、貓、果子貍等成蟲。終宿主為犬、貓、果子貍等 生活史生活史： 蟲卵隨糞便或痰入水 25-30C，21天孵出毛蚴 第一中間宿主第一中間宿主：淡水螺。無性生殖發育，3個月左右，尾蚴逸出。20 C水中存活1-2天 第二中間宿主：第二中間宿主：甲殼動物

3、（溪蟹、喇蛄），形成囊蚴，囊蚴囊蚴是并殖吸蟲的感染型是并殖吸蟲的感染型 人吞食含有并殖吸蟲活囊蚴的溪蟹或喇蛄而感染 幼蟲在小腸內逸出，侵入組織，在體內游走，蟲體竄行游走和貫穿組織能力強，主要寄生于肺組織（衛氏） 囊蚴感染制成蟲發育成熟需2-3個月。壽命6-20年 傳染源：傳染源：病人是衛氏病殖吸蟲的重要傳染源。通過痰或糞便排出蟲卵。某些家畜和野獸是并殖吸蟲的保蟲宿主和傳染源。病人不是斯氏并殖吸蟲的主要傳染源。犬、貓、果子貍等為其保蟲宿主和傳染源 傳播途徑：傳播途徑：生食或半生食含有囊蚴的溪蟹、喇蛄或進食含有童蟲的野豬肉或生飲溪水而感染 易感人群：易感人群：普遍易感。 流行特征：流行特征：分布廣

4、泛。東北地區為喇蛄型衛氏并殖吸蟲流行區 童蟲引起的病變：童蟲引起的病變：后尾蚴和童蟲在腸道和腹腔及胸腔內竄行游走引起竇道和炎癥滲出。斯氏并殖吸蟲可引起寄生部位嗜酸性肉芽腫，形成游走性皮下包塊，滲出性胸膜炎和肝損害較重 成蟲引起的病變：成蟲引起的病變：可固定于某一部位，也可游走竄行。形成多房性膿腫、囊腫、結節與瘢痕 蟲卵引起的病變：蟲卵引起的病變：組織反應輕微基本病理改變：膿腫期：膿腫期：單核細胞、嗜酸性粒細胞和中性粒細胞浸潤囊腫期：囊腫期：肉芽組織形成，圍以纖維囊壁，囊內有棕褐色囊液纖維瘢痕期：纖維瘢痕期：肉芽組織和纖維組織增生 潛伏期3-6個月。臨床表現復雜，起病緩慢 急性并殖吸蟲病； 慢性

5、并殖吸蟲病：衛氏并殖吸蟲和斯氏并殖吸蟲的臨床表現不同衛氏并殖吸蟲和斯氏并殖吸蟲的臨床表現不同見表見表全身癥狀：發熱（低熱）、頭痛、胸悶，全身癥狀：發熱（低熱）、頭痛、胸悶，過敏癥狀（蕁麻疹、哮喘）。斯氏并殖吸蟲多過敏癥狀（蕁麻疹、哮喘）。斯氏并殖吸蟲多見見臨床分型：臨床分型：胸肺型：咳嗽、咳痰、咯血、胸痛、氣短。鐵鐵銹色或棕褐色爛桃樣血痰為最典型癥狀。銹色或棕褐色爛桃樣血痰為最典型癥狀。（為肺部壞死組織，痰中可查到蟲卵）有單側或雙側胸腔積液。 衛氏并殖吸蟲病衛氏并殖吸蟲病 斯氏并殖吸蟲病斯氏并殖吸蟲病全身癥狀全身癥狀 不常見不常見 常見常見蕁麻疹蕁麻疹 不常見不常見 很常見很常見咳嗽咳嗽 明顯

6、，伴中等或大量痰液明顯，伴中等或大量痰液 輕咳，痰量很少輕咳，痰量很少咳痰咳痰 鐵銹色痰，棕褐色痰或爛桃肉樣鐵銹色痰，棕褐色痰或爛桃肉樣 血絲痰血絲痰胸膜炎、胸腔積液胸膜炎、胸腔積液 較少見較少見 常見常見肺部損害肺部損害 常見常見 少見少見肝損害肝損害 較少見較少見 較常見較常見皮下結節與包塊皮下結節與包塊 10-20%病人可見，結節內查見病人可見，結節內查見 30-70%病人可見，有游走病人可見，有游走 蟲卵或成蟲蟲卵或成蟲 性包塊，包塊內偶見幼蟲，性包塊，包塊內偶見幼蟲， 未見成蟲或蟲卵未見成蟲或蟲卵 腹型：腹型：腹痛（陣發性或下腹隱痛）、腹瀉、惡心、嘔吐、肝腫大和肝功能異常。膿腫破潰可

7、排棕褐色粘稠血便。斯氏并殖吸蟲可引起肝功能異常 腦脊髓型：腦脊髓型：2-5%，衛氏并殖吸蟲多見 腦型：腦型：兒童和青壯年嚴重感染者。 顱內壓增高癥狀：多見于早期 腦組織破壞癥狀：后期出現 刺激性癥狀：癲癇發作 炎癥性癥狀：多見于早期 脊髓型：脊髓型：運動障礙、感覺缺失、坐骨神經痛、大小便失禁皮膚型：皮下結節或包塊陰囊腫塊型：亞臨床型：疫區多見隱性感染 一般檢查一般檢查: 血象血象：白細胞總數增高，急性期嗜酸粒細胞可達80%以上。 腦脊液、胸腹水腦脊液、胸腹水：嗜酸粒細胞增高 血沉：血沉：增快 病原檢查：病原檢查： 痰查蟲卵，糞便查蟲卵 體液：查蟲卵，嗜酸細胞增多，夏科雷登結晶 皮下結節和包塊活

8、檢 免疫學檢查免疫學檢查： 皮內試驗：1：2000成蟲抗原接種前臂皮內。篩查 酶聯免疫吸附試驗：與病人蟲卵陽性符合率達100%。滴度 1：800可以確診。考核療效 快速斑點酶聯免疫吸附試驗或單克隆抗體蛋白印記（western blot)：早期診斷 后尾蚴膜反應、間接血凝試驗、間接熒光抗體試驗、RIA、ABC-ELISA等 X線檢查：線檢查：早期。肺部炎性浸潤，囊腫及胸腔積液 CT 流行病學資料：流行病學資料： 臨床資料：臨床資料： 實驗室檢查實驗室檢查：痰、糞便或體液中查到蟲卵，皮下結節活檢發現蟲卵、童蟲、或成蟲可以確診。免疫學檢查有診斷意義肺結核、肺癌肺結核、肺癌腦部寄生蟲病和腦腫瘤腦部寄生

9、蟲病和腦腫瘤病毒性肝炎、肝膿腫病毒性肝炎、肝膿腫一般預后較好，腦脊髓型療效較差。斯氏貍殖吸蟲預后較好病原治療：病原治療：吡喹酮：治療首選,25mg/kg,每日3次，連服2-3天阿苯達唑：對斯氏并殖吸蟲效果較好硫氯酚（別丁）：用于流行區犬或豬的治療對癥治療：對癥治療：鎮咳、鎮痛、止血；鎮靜、脫水；針刺、理療等。腦脊髓型內科治療無效可外科手術控制傳染源控制傳染源：徹底治療病人和病畜切斷傳播途徑切斷傳播途徑：防止糞便入水；消滅淡水螺保護易感人群保護易感人群：良好的飲食習慣EEEEEEEDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDCCCCCCCCCCCCCCCCCCCCCC

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