NemotodaCestodaTrematodaMedicalhelminth.NemotodaMedicalhelminth.1LiverFluke.VocabularyDioecism[dai‘i:siz?m]雌雄異體Hermaphroditic[h?:m?fr?‘ditik]雌雄同體Miracidium[‘mair?‘sidi?m]毛蚴Sporocyst[‘sp?:r?‘sist]胞蚴Encytedmetacercaria[‘met?s?:’k??ri?]囊蚴Rediae雷蚴Cercariae尾蚴Encyst-excyst成囊-脫囊.LiverFluke.VocabularyDioecism2LiverFluke.VocabularyBile膽汁Clonorchiasis[’kl?un?:’kai?sis]

肝吸蟲病Intrahepaticbileduct肝膽管Pancreatic胰腺的Gallbladder膽囊Faeces[’fi:si:z]糞便Diarrhoea[’da??’r??]腹瀉putrescent[pju:’tresnt]

壞死.LiverFluke.VocabularyBile膽汁3LiverFluke.VocabularyHepatocirrhosis

[’hep?t?usi’r?usis]肝硬化Atrophy[’?tr?fi]萎縮ascites[?’saiti:z]腹水.LiverFluke.VocabularyHepatoci4

Trematodes,FlukesGeneralcharacters.Trematodes,FlukesGeneralcha5

MophologyGeneralcharacters

Leave-shaped,flatHermaphroditic(exceptSchistosome)havemouthbutnoanusWithoralsuckerandventralsuckerMostfluke’segghasaoperculum.MophologyGeneralcharacters6Adultworms

eggscercariaRediaeSporocystMiracidia

encystedmetacercariaLifecycleDefinitivehostSecondintermediatehostFirstintermediatehostGeneralcharacters

Mophology.AdultwormscercariaRediaeSpor7metagenesisasexualgenerationSexualgenerationGeneralcharacters

MophologyLifecycle.metagenesisasexualgenerationS8Morethan30speciesofflukesparasiticinhumanbody,allbelongtoPhylumPlatyminthes(扁形動物門）

ClassTrematoda（吸蟲綱）

OrderDigenea（復殖目）Generalcharacters

speciesofflukes.Morethan30speciesoffluke9Flukesendemicinchina

Clonorchissinensis華支睪吸蟲

Paragonimuswestermani

衛氏并殖吸蟲

Schistosomajaponicum

日本血吸蟲

Fasciolopsisbuski

布氏姜片吸蟲

Pagumogonimusskrjabini

斯氏貍殖吸蟲Generalcharacters

speciesofflukes.FlukesendemicinchinaClono10華支睪吸蟲(Clonorchissinensis)introduction肝吸蟲(liverfluke）causingClonorchiasisFirstlyfoundinaIndianChinese’sbileductin1874..華支睪吸蟲(Clonorchissinensis)intr11

MorphologyLifecyclePathogenesisDiagnosisPrevalenceProphylaxis肝吸蟲(liverfluke）華支睪吸蟲(Clonorchissinensis).Morphology肝吸蟲(liverfluke）華支睪12LiverflukeMorphology10-25×3-5mmOralsuckerVentralsuckerSpermary睪丸Uterus子宮Intestinebranch1.AdultwormGullet咽Overy卵巢.LiverflukeMorphology10-25×3-131.AdultwormLiverflukemorphology.1.AdultwormLiverflukemorpho14Sesamelike,broadlyovoidLightyellowish-brown2.egg29×17um，sizecolorshapeshellContainingWithadistinctconvexoperculumamiracidiuminsidetheeggLiverflukemorphology.Sesamelike,broadlyovoidLigh152.egg卵蓋operculum肩峰shoulder卵殼shell毛蚴miracidium疣狀突起tinyknobLiverflukemorphologysizecolorshapeshellContaining.2.egg卵蓋operculum肩峰shoulder卵殼s16蠕蟲卵中我最小，形似芝麻棕黃色。上有蓋來下有疣，肩峰明顯內毛蚴。2.eggLiverflukemorphology.蠕蟲卵中我最小，2.eggLiverflukemorph17MiracidiumLiverflukemorphology3.Otherstage.MiracidiumLiverflukemorpholo18Liverflukemorphologyotherstages

sporocyst3.Otherstage.Liverflukemorphologyothers19rediaeLiverflukemorphologyotherstages

GenerationcellUnmatureCercariae3.Otherstage.rediaeLiverflukemorphologyo20CercariaeLiverflukemorphologyotherstages

3.Otherstage.CercariaeLiverflukemorpholog21Liverflukemorphologyotherstages

FreshwaterfishEncystedmetacercariaeinfishmusculature3.Otherstage.Liverflukemorphologyothers22Liverflukelifecycle

FirstintermidiatehostSecondintermidiatehostDefinitivehostshrimpCyprinidaesnail.LiverflukelifecycleFirst23Liverflukelifecycle

Adult

wormseggmiracidiumSporacyst

rediaecercariaeEncyctedmtacercariae.LiverflukelifecycleAdult24尾蚴雷蚴胞蚴毛蚴囊蚴貓25-30d鼠21d100d25℃時，30-40d童蟲成蟲卵Liverflukelifecycle

.尾蚴雷蚴胞蚴毛蚴囊蚴貓25-30d100d25℃時，30-251.host紋沼螺長角涵螺赤豆螺(1)thefirstintermediatehost—freshwatersnailLiverflukelifecycle

.1.host紋沼螺(1)thefirstint261.host(1)thefirstintermediatehost—freshwatersnail(2)thesecondintermediatehost—

freshwaterfish(familyCyprinidae鯉科)Liverflukelifecycleconclusion

.1.host(1)thefirstintermedia27(3)Definitivehost—human，cat,dog,pig,rat,etal.

1.Host(1)thefirstintermediatehost—

freshwatersnail(2)thesecondintermediatehost—

freshwaterfish(familyCyprinidae)Liverflukelifecycleconclusion

.(3)Definitivehost1.Host(1281.Host2.Infectionstageandmethodinfectionstage----encystedmetacercariaeinfectionway----ingestionofraw,undercooked,pickledfishharbouringmetacercariaeLiverflukelifecycleconclusion

.1.Hostinfectionstage----ency291.Host2.Infectionstageandmethod3.ExcretewayinhumanbodyInmaturewormcommonbileductbloodstreamabdomenantrum

BilepassagesLiverflukelifecycleconclusion

through.1.HostInmaturecommonbiledu301.Host2.Infectionstageandmethod3.Excretewayinhumanbody4.Parasiting

position

AdultwormsareparasiticinbileductsLiverflukelifecycleconclusion

.1.HostAdultwormsareLiverf311.host2.infectionstageandmethod3.passingwayinhumanbody4.parasitizedposition5.leavingbodystageandmethod

eggsexitthebileductandareexcretedinthefaecesLiverflukelifecycleconclusion

.1.hosteggsexitthebiledu32PathogeneticstagePathogeneticmechenismSymptomologyLiverflukepathogenicity

.PathogeneticstageLiverfluke33ImmatureadultwormMatureadultwormEggsLiverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.ImmatureadultwormLiverfluke34metablitesandmechanicaleffectscausesproliferativeandinflammatoryreactionsinthebiliaryepitheliumofthebileducts.Encapsulating

fibrosisoftheductsBile

ductsaredilatedatthepointswheretheflukesareattachedtotheinnerliningpathogeneticstagePathogeneticmechanismSymptomologyLiverflukepathogenicity

.metablitesandmechanicaleff35②chronicinfection,hepaticcellsnearthebilepassagesbecomedenaturalizedand

putrescent(壞死)，causinghepatictissueatrophy(萎縮)apparently.③lateperiod,causinghepatocirrhosis(肝硬化)andascites(腹水).①ifparasitizedbylargeamountofflukes,bileductwillbeobstructed,bileisblockedandicteruswillhappen.Liverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.②chronicinfection,hepaticce36OtherdiseasescausedCholecystitis(膽囊炎)，cholangitis(膽管炎)，hepatitis(肝炎)；cholelithiasis(膽石癥)pancreaticinflammatory(胰腺炎)cholangiocarcinoma(膽管上皮癌)hepatiticcancer肝癌；hypogenesis(發育不良)Liverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.OtherdiseasescausedLiverfl37頭痛乏力，消化不良；腹痛腹瀉，上腹不適；肝區隱痛，常不明顯。頭乏消肝痛，三腹并不適Liverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomologyHeadache,beingtiredanddyspepsia,abdominaldistress,diarrhoea,midsectionbeingdiscomfortable,andwithminorsymptomofacheinliver..頭痛乏力，消化不良；頭乏消肝痛，三腹并不適Liverfl38withasymptomoftumefactionintheliverandspleenLiverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.withasymptomoftumefaction391.diagnosisofpathogenyoffecesby（steakfecesonaslide,concentrationofeggs）ofaspiratedbilebyduodenalaspiration

膽汁（十二指腸引流）LiverflukediagnosisdemonstrationofEggsbymicroscopicalexamination.1.diagnosisofpathogenyof402.immunodiagnosis（forscreeningpatientsprimarily,andassistanceofdiagnosis）skintestusingextractsofadultliverfluke皮試indirecthaemagglutinationassay(IHA)ELISALiverflukediagnosisDemonstrationofantibodiesagainstliverfluke.2.immunodiagnosis（forscreenin411.distributionallovertheworld,especiallyinChina,Japan,Korea,Vietnam,andSouthestAsia我國：內.寧.西.海.新尚無內蒙、寧夏、西藏青海、新疆高發區：珠江三角洲Liverflukeprevalence.1.distributionalloverthewo421.ditribution2.elementsrelevanttoprevalenceIntermidiatedhostThechanceofswallowingtheencystedmetacercariaeThesouceofinfectionEggsenterwaterLiverflukeprevalence.1.ditribution2.elementsreleva431997年廣東省不同魚種肝吸蟲的感染率（%）麥穗魚61.22白鰱56.3白鯇55.6花鰱54.6Liverflukeprevalence.1997年廣東省不同魚種肝吸蟲的感染率（%）Liverfl44IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeThesouceofinfectionEggsenterwaterLiverflukeprophylaxis.IntermidiatedThechanceofsw45IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeThesouceofinfectionEggsenterwaterLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson.IntermidiatedThechanceofsw46IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeEggsenterwaterLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson.IntermidiatedThechanceofsw47IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeEggsenterwaterLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces..IntermidiatedThechanceofsw48IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces..IntermidiatedThechanceofsw49IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces.3.Changethehabitofeating(uncookedfish)；.IntermidiatedThechanceofsw50IntermidiatedhostLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces.3.Changethehabitofeating(uncookedfish)；.IntermidiatedLiverflukepr51并殖吸蟲（Paragonimus)第三節.肺吸蟲（lungflukes)概述衛氏并殖吸蟲（肺型）斯氏貍殖吸蟲（皮膚型）.并殖吸蟲（Paragonimus)第三節.肺吸蟲（lung52并殖吸蟲（Paragonimus)（一）肺吸蟲（lungflukes)衛氏并殖吸蟲.并殖吸蟲（Paragonimus)（一）肺吸蟲（lungf53肺吸蟲形態

1.成蟲

長7-12mm寬4-6mm厚3.5-5.肺吸蟲形態1.成蟲長7-12mm.54肺吸蟲形態

1.成蟲體棘游走習性.肺吸蟲形態1.成蟲體棘游走習性.55肺吸蟲形態

2.蟲卵大小顏色形狀結構56100um.肺吸蟲形態2.蟲卵大小顏色形狀結構56100um56肺吸蟲形態

2.蟲卵卵殼卵黃細胞卵細胞卵蓋56100um大小顏色形狀結構.肺吸蟲形態2.蟲卵卵殼卵黃細胞卵細胞卵蓋56100um57肺吸蟲形態

3.其他雷蚴囊蚴尾蚴.肺吸蟲形態3.其他雷蚴囊蚴尾蚴.58肺吸蟲生活史

.肺吸蟲生活史.59尾蚴母雷蚴子雷蚴胞蚴毛蚴童蟲成蟲卵囊蚴肺吸蟲生活史

.尾蚴母雷蚴胞蚴毛蚴童蟲囊蚴肺吸蟲生活史.601.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式①第一中間宿主—川卷螺肺吸蟲生活史

.1.宿主①第一中間宿主—川卷螺肺吸蟲生活史.611.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式①第一中間宿主—川卷螺②第二中間宿主—溪蟹、蝲蛄肺吸蟲生活史

.1.宿主①第一中間宿主—川卷螺②第二中間宿主—溪蟹621.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式③終宿主—人，肉食性的哺乳動物

（保蟲宿主）①第一中間宿主—川卷螺②第二中間宿主—溪蟹、蝲蛄肺吸蟲生活史

.1.宿主③終宿主—人，肉食性的哺乳動物①第一中間宿主631.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式感染階段：囊蚴感染方式：生食/半生食溪蟹、蝲蛄

肺吸蟲生活史

.1.宿主感染階段：囊蚴肺吸蟲生活史.641.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式肺吸蟲生活史

皮下腸壁腹腔膈肌胸腔肺童蟲腹壁縱隔心、腦.1.宿主肺吸蟲生活史皮下腸壁腹腔膈肌胸腔肺童蟲腹壁縱隔心651.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式肺吸蟲生活史

蟲囊.1.宿主肺吸蟲生活史蟲囊.661.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段及方式肺吸蟲生活史

蟲卵去向：蟲囊完整時，蟲卵沉積于囊內；蟲囊與血管相通：引起小血管栓塞；蟲囊與淋巴管相通：蟲卵沉積于肺淋巴結；

蟲囊與支氣管相通：蟲卵隨痰/糞排出體外。.1.宿主肺吸蟲生活史蟲卵去向67肺吸蟲致病

致病階段致病機理臨床表現.肺吸蟲致病致病階段.68肺吸蟲致病

致病階段致病機理臨床表現童蟲、成蟲.肺吸蟲致病致病階段童蟲、成蟲.69肺吸蟲致病

致病階段致病機理臨床表現童蟲/成蟲的機械性損傷及異物反應。膿腫期囊腫期纖維斑痕期肺型肺吸蟲病：.肺吸蟲致病致病階段童蟲/成蟲的機械性損傷及異物反應。膿70肺吸蟲致病

致病階段致病機理臨床表現童蟲/成蟲的機械性損傷及異物反應。膿腫期囊腫期纖維斑痕期細胞浸潤局部出血組織壞死肉芽組織增生并包圍蟲體，囊內可見大量蟲卵和夏科雷登結晶蟲體轉移或死亡，形成疤痕病理變化X線特征浸潤性陰影多房性囊樣陰影硬結性或條索性陰影肺型肺吸蟲病：.肺吸蟲致病致病階段童蟲/成蟲的機械性損傷及異物反應。膿71肺吸蟲致病

致病階段致病機理臨床表現童蟲/成蟲的機械性損傷及異物反應。肺型肺吸蟲病：腹腔型：引起廣泛的炎癥反應和粘連胸腔型：胸膜炎，縱隔炎腦型：占位性病變及損傷皮膚型：游走性的皮下包塊或結節.肺吸蟲致病致病階段童蟲/成蟲的機械性損傷及異物反應。72肺吸蟲致病

致病階段致病機理臨床表現輕癥：表現為食欲不振、乏力、消瘦、低熱等非特異性癥狀；重癥：毒性癥狀明顯，如高熱、腹痛、腹瀉等。血象：白細胞↑，嗜酸性粒細胞↑↑（20--40%）.肺吸蟲致病致病階段輕癥：表現為食欲不振、乏力、消重癥731.病原檢查：①查蟲卵：痰、糞便②組織活檢：皮下包塊2.免疫學診斷：

①皮試：陽性率可達98-100%②IHA：陽性滴度在1：20以上；③ELISA：陽性率可達90-100%。肺吸蟲實驗診斷

.1.病原檢查：2.免疫學診斷：肺吸蟲實驗診斷.74..75五、傳播與流行流行因素：1、病人和保蟲宿主的存在：犬、貓、豬2、中間宿主的存在：第一中間宿營主——川卷螺有十多種第二中間宿主——淡水蟹能傳播衛氏并殖吸蟲者有20余種。3、生吃或半生吃溪蟹、喇蛄或動物肉類（轉續宿主）的不良習慣。.五、傳播與流行流行因素：.76六、防治原則（一）防止病從口入，不吃生食，不喝生水，防止囊蚴污染餐具。（二）加強糞便管理，不隨地吐痰。（三）治療病人，病畜，常用藥物有吡喹酮、硫雙二氯酚）又名別丁）等。.六、防治原則（一）防止病從口入，不吃生食，不喝生水，防止囊蚴77小結1、肝吸蟲卵是腸道寄生蟲卵中最小的蟲卵之一，鏡下呈芝麻狀；顏色是棕黃色；卵殼具卵蓋；蓋上有肩峰；底部有一疣狀突起；內容物是一條毛蚴。2、肝吸蟲生活史過程中第一中間宿主是淡水螺，第二中間宿主是淡水魚蝦。3、肝吸蟲寄生于肝膽管，蟲體的機械刺激及分泌物的化學刺激，使肝膽管上皮細胞脫落增生，管壁因結締組織增生而增厚。.小結1、肝吸蟲卵是腸道寄生蟲卵中最小的蟲卵之一，鏡下呈芝麻狀78小結4、病原學診斷：查蟲卵，十二指腸引流膽汁進行離心沉淀查蟲卵。5、肺吸蟲卵較大；橢圓形；金黃色；卵殼表面光滑，厚薄不均，大多有卵蓋；內容物是一個卵細胞及十多個卵黃細胞6、肺吸蟲成蟲寄生于肺，但有腹腔型、胸腔型、腦型、皮膚型的異位寄生。.小結4、病原學診斷：查蟲卵，十二指腸引流膽汁進行離心沉淀查蟲79問答題：1、肝吸蟲病、肺吸蟲病的防治應注意哪些環節？2、肝肺吸蟲病的臨床表現有哪些？.問答題：1、肝吸蟲病、肺吸蟲病的防治應注意哪些環節？.80..81NemotodaCestodaTrematodaMedicalhelminth.NemotodaMedicalhelminth.82LiverFluke.VocabularyDioecism[dai‘i:siz?m]雌雄異體Hermaphroditic[h?:m?fr?‘ditik]雌雄同體Miracidium[‘mair?‘sidi?m]毛蚴Sporocyst[‘sp?:r?‘sist]胞蚴Encytedmetacercaria[‘met?s?:’k??ri?]囊蚴Rediae雷蚴Cercariae尾蚴Encyst-excyst成囊-脫囊.LiverFluke.VocabularyDioecism83LiverFluke.VocabularyBile膽汁Clonorchiasis[’kl?un?:’kai?sis]

肝吸蟲病Intrahepaticbileduct肝膽管Pancreatic胰腺的Gallbladder膽囊Faeces[’fi:si:z]糞便Diarrhoea[’da??’r??]腹瀉putrescent[pju:’tresnt]

壞死.LiverFluke.VocabularyBile膽汁84LiverFluke.VocabularyHepatocirrhosis

[’hep?t?usi’r?usis]肝硬化Atrophy[’?tr?fi]萎縮ascites[?’saiti:z]腹水.LiverFluke.VocabularyHepatoci85

Trematodes,FlukesGeneralcharacters.Trematodes,FlukesGeneralcha86

MophologyGeneralcharacters

Leave-shaped,flatHermaphroditic(exceptSchistosome)havemouthbutnoanusWithoralsuckerandventralsuckerMostfluke’segghasaoperculum.MophologyGeneralcharacters87Adultworms

eggscercariaRediaeSporocystMiracidia

encystedmetacercariaLifecycleDefinitivehostSecondintermediatehostFirstintermediatehostGeneralcharacters

Mophology.AdultwormscercariaRediaeSpor88metagenesisasexualgenerationSexualgenerationGeneralcharacters

MophologyLifecycle.metagenesisasexualgenerationS89Morethan30speciesofflukesparasiticinhumanbody,allbelongtoPhylumPlatyminthes(扁形動物門）

ClassTrematoda（吸蟲綱）

OrderDigenea（復殖目）Generalcharacters

speciesofflukes.Morethan30speciesoffluke90Flukesendemicinchina

Clonorchissinensis華支睪吸蟲

Paragonimuswestermani

衛氏并殖吸蟲

Schistosomajaponicum

日本血吸蟲

Fasciolopsisbuski

布氏姜片吸蟲

Pagumogonimusskrjabini

斯氏貍殖吸蟲Generalcharacters

speciesofflukes.FlukesendemicinchinaClono91華支睪吸蟲(Clonorchissinensis)introduction肝吸蟲(liverfluke）causingClonorchiasisFirstlyfoundinaIndianChinese’sbileductin1874..華支睪吸蟲(Clonorchissinensis)intr92

MorphologyLifecyclePathogenesisDiagnosisPrevalenceProphylaxis肝吸蟲(liverfluke）華支睪吸蟲(Clonorchissinensis).Morphology肝吸蟲(liverfluke）華支睪93LiverflukeMorphology10-25×3-5mmOralsuckerVentralsuckerSpermary睪丸Uterus子宮Intestinebranch1.AdultwormGullet咽Overy卵巢.LiverflukeMorphology10-25×3-941.AdultwormLiverflukemorphology.1.AdultwormLiverflukemorpho95Sesamelike,broadlyovoidLightyellowish-brown2.egg29×17um，sizecolorshapeshellContainingWithadistinctconvexoperculumamiracidiuminsidetheeggLiverflukemorphology.Sesamelike,broadlyovoidLigh962.egg卵蓋operculum肩峰shoulder卵殼shell毛蚴miracidium疣狀突起tinyknobLiverflukemorphologysizecolorshapeshellContaining.2.egg卵蓋operculum肩峰shoulder卵殼s97蠕蟲卵中我最小，形似芝麻棕黃色。上有蓋來下有疣，肩峰明顯內毛蚴。2.eggLiverflukemorphology.蠕蟲卵中我最小，2.eggLiverflukemorph98MiracidiumLiverflukemorphology3.Otherstage.MiracidiumLiverflukemorpholo99Liverflukemorphologyotherstages

sporocyst3.Otherstage.Liverflukemorphologyothers100rediaeLiverflukemorphologyotherstages

GenerationcellUnmatureCercariae3.Otherstage.rediaeLiverflukemorphologyo101CercariaeLiverflukemorphologyotherstages

3.Otherstage.CercariaeLiverflukemorpholog102Liverflukemorphologyotherstages

FreshwaterfishEncystedmetacercariaeinfishmusculature3.Otherstage.Liverflukemorphologyothers103Liverflukelifecycle

FirstintermidiatehostSecondintermidiatehostDefinitivehostshrimpCyprinidaesnail.LiverflukelifecycleFirst104Liverflukelifecycle

Adult

wormseggmiracidiumSporacyst

rediaecercariaeEncyctedmtacercariae.LiverflukelifecycleAdult105尾蚴雷蚴胞蚴毛蚴囊蚴貓25-30d鼠21d100d25℃時，30-40d童蟲成蟲卵Liverflukelifecycle

.尾蚴雷蚴胞蚴毛蚴囊蚴貓25-30d100d25℃時，30-1061.host紋沼螺長角涵螺赤豆螺(1)thefirstintermediatehost—freshwatersnailLiverflukelifecycle

.1.host紋沼螺(1)thefirstint1071.host(1)thefirstintermediatehost—freshwatersnail(2)thesecondintermediatehost—

freshwaterfish(familyCyprinidae鯉科)Liverflukelifecycleconclusion

.1.host(1)thefirstintermedia108(3)Definitivehost—human，cat,dog,pig,rat,etal.

1.Host(1)thefirstintermediatehost—

freshwatersnail(2)thesecondintermediatehost—

freshwaterfish(familyCyprinidae)Liverflukelifecycleconclusion

.(3)Definitivehost1.Host(11091.Host2.Infectionstageandmethodinfectionstage----encystedmetacercariaeinfectionway----ingestionofraw,undercooked,pickledfishharbouringmetacercariaeLiverflukelifecycleconclusion

.1.Hostinfectionstage----ency1101.Host2.Infectionstageandmethod3.ExcretewayinhumanbodyInmaturewormcommonbileductbloodstreamabdomenantrum

BilepassagesLiverflukelifecycleconclusion

through.1.HostInmaturecommonbiledu1111.Host2.Infectionstageandmethod3.Excretewayinhumanbody4.Parasiting

position

AdultwormsareparasiticinbileductsLiverflukelifecycleconclusion

.1.HostAdultwormsareLiverf1121.host2.infectionstageandmethod3.passingwayinhumanbody4.parasitizedposition5.leavingbodystageandmethod

eggsexitthebileductandareexcretedinthefaecesLiverflukelifecycleconclusion

.1.hosteggsexitthebiledu113PathogeneticstagePathogeneticmechenismSymptomologyLiverflukepathogenicity

.PathogeneticstageLiverfluke114ImmatureadultwormMatureadultwormEggsLiverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.ImmatureadultwormLiverfluke115metablitesandmechanicaleffectscausesproliferativeandinflammatoryreactionsinthebiliaryepitheliumofthebileducts.Encapsulating

fibrosisoftheductsBile

ductsaredilatedatthepointswheretheflukesareattachedtotheinnerliningpathogeneticstagePathogeneticmechanismSymptomologyLiverflukepathogenicity

.metablitesandmechanicaleff116②chronicinfection,hepaticcellsnearthebilepassagesbecomedenaturalizedand

putrescent(壞死)，causinghepatictissueatrophy(萎縮)apparently.③lateperiod,causinghepatocirrhosis(肝硬化)andascites(腹水).①ifparasitizedbylargeamountofflukes,bileductwillbeobstructed,bileisblockedandicteruswillhappen.Liverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.②chronicinfection,hepaticce117OtherdiseasescausedCholecystitis(膽囊炎)，cholangitis(膽管炎)，hepatitis(肝炎)；cholelithiasis(膽石癥)pancreaticinflammatory(胰腺炎)cholangiocarcinoma(膽管上皮癌)hepatiticcancer肝癌；hypogenesis(發育不良)Liverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.OtherdiseasescausedLiverfl118頭痛乏力，消化不良；腹痛腹瀉，上腹不適；肝區隱痛，常不明顯。頭乏消肝痛，三腹并不適Liverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomologyHeadache,beingtiredanddyspepsia,abdominaldistress,diarrhoea,midsectionbeingdiscomfortable,andwithminorsymptomofacheinliver..頭痛乏力，消化不良；頭乏消肝痛，三腹并不適Liverfl119withasymptomoftumefactionintheliverandspleenLiverflukepathogenicity

pathogeneticstagePathogeneticmechanismSymptomology.withasymptomoftumefaction1201.diagnosisofpathogenyoffecesby（steakfecesonaslide,concentrationofeggs）ofaspiratedbilebyduodenalaspiration

膽汁（十二指腸引流）LiverflukediagnosisdemonstrationofEggsbymicroscopicalexamination.1.diagnosisofpathogenyof1212.immunodiagnosis（forscreeningpatientsprimarily,andassistanceofdiagnosis）skintestusingextractsofadultliverfluke皮試indirecthaemagglutinationassay(IHA)ELISALiverflukediagnosisDemonstrationofantibodiesagainstliverfluke.2.immunodiagnosis（forscreenin1221.distributionallovertheworld,especiallyinChina,Japan,Korea,Vietnam,andSouthestAsia我國：內.寧.西.海.新尚無內蒙、寧夏、西藏青海、新疆高發區：珠江三角洲Liverflukeprevalence.1.distributionalloverthewo1231.ditribution2.elementsrelevanttoprevalenceIntermidiatedhostThechanceofswallowingtheencystedmetacercariaeThesouceofinfectionEggsenterwaterLiverflukeprevalence.1.ditribution2.elementsreleva1241997年廣東省不同魚種肝吸蟲的感染率（%）麥穗魚61.22白鰱56.3白鯇55.6花鰱54.6Liverflukeprevalence.1997年廣東省不同魚種肝吸蟲的感染率（%）Liverfl125IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeThesouceofinfectionEggsenterwaterLiverflukeprophylaxis.IntermidiatedThechanceofsw126IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeThesouceofinfectionEggsenterwaterLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson.IntermidiatedThechanceofsw127IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeEggsenterwaterLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson.IntermidiatedThechanceofsw128IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeEggsenterwaterLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces..IntermidiatedThechanceofsw129IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces..IntermidiatedThechanceofsw130IntermidiatedhostThechanceofswallowingtheencystedmetacercariaeLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces.3.Changethehabitofeating(uncookedfish)；.IntermidiatedThechanceofsw131IntermidiatedhostLiverflukeprophylaxis1.Curethepatientsandasymptomaticinfectedperson2.Dealwithfeces.3.Changethehabitofeating(uncookedfish)；.IntermidiatedLiverflukepr132并殖吸蟲（Paragonimus)第三節.肺吸蟲（lungflukes)概述衛氏并殖吸蟲（肺型）斯氏貍殖吸蟲（皮膚型）.并殖吸蟲（Paragonimus)第三節.肺吸蟲（lung133并殖吸蟲（Paragonimus)（一）肺吸蟲（lungflukes)衛氏并殖吸蟲.并殖吸蟲（Paragonimus)（一）肺吸蟲（lungf134肺吸蟲形態

1.成蟲

長7-12mm寬4-6mm厚3.5-5.肺吸蟲形態1.成蟲長7-12mm.135肺吸蟲形態

1.成蟲體棘游走習性.肺吸蟲形態1.成蟲體棘游走習性.136肺吸蟲形態

2.蟲卵大小顏色形狀結構56100um.肺吸蟲形態2.蟲卵大小顏色形狀結構56100um137肺吸蟲形態

2.蟲卵卵殼卵黃細胞卵細胞卵蓋56100um大小顏色形狀結構.肺吸蟲形態2.蟲卵卵殼卵黃細胞卵細胞卵蓋56100um138肺吸蟲形態

3.其他雷蚴囊蚴尾蚴.肺吸蟲形態3.其他雷蚴囊蚴尾蚴.139肺吸蟲生活史

.肺吸蟲生活史.140尾蚴母雷蚴子雷蚴胞蚴毛蚴童蟲成蟲卵囊蚴肺吸蟲生活史

.尾蚴母雷蚴胞蚴毛蚴童蟲囊蚴肺吸蟲生活史.1411.宿主2.感染階段及方式3.移行途徑4.寄生部位5.離體階段