教學(xué)課題：并殖吸蟲(chóng)

（肺吸蟲(chóng)）教學(xué)目標(biāo)：

1.掌握衛(wèi)氏肺吸蟲(chóng)成蟲(chóng)、蟲(chóng)卵和斯氏肺吸蟲(chóng)童蟲(chóng)形態(tài)，生活史和致病作用。2.熟悉并殖吸蟲(chóng)試驗(yàn)診療。3.了解并殖吸蟲(chóng)流行情況及防治標(biāo)準(zhǔn)。教學(xué)重點(diǎn)：蟲(chóng)卵形態(tài)、生活史特點(diǎn)、致病性教學(xué)難點(diǎn)：致病機(jī)制衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)1/56衛(wèi)氏并殖吸蟲(chóng)（肺吸蟲(chóng)）一、形態(tài)

1.成蟲(chóng)：外形、吸盤(pán)、生殖系統(tǒng)特點(diǎn)。衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)2/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)3/56衛(wèi)氏并殖吸蟲(chóng)活體衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)4/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)5/56衛(wèi)氏并殖吸蟲(chóng)活囊蚴衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)6/56衛(wèi)氏并殖吸蟲(chóng)囊蚴內(nèi)幼蟲(chóng)孵出衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)7/562.肺吸蟲(chóng)卵：口訣肺吸蟲(chóng)卵象酒壇，金黃顏色真好看；卵蓋扣在肩峰上，內(nèi)有卵黃受精卵。衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)8/56二、生活史1.發(fā)育過(guò)程：1）在中間宿主體內(nèi)發(fā)育2）在終宿主體內(nèi)發(fā)育

衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)9/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)10/56肺吸蟲(chóng)第一中間宿主：川卷螺衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)11/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)12/56衛(wèi)氏肺吸蟲(chóng)第二中間宿主：蝲蛄衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)13/56活淡水蟹衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)14/56衛(wèi)氏并殖吸蟲(chóng)（肺吸蟲(chóng)）二、生活史

2.生活史特點(diǎn)

1）成蟲(chóng)寄生部位—肺部等組織2）感染階段—囊蚴3）感染方式—經(jīng)口4）宿主：a.中間宿主：第一中間宿主—川卷螺第二中間宿主—石蟹等b.終宿主—人c.儲(chǔ)存宿主—食肉動(dòng)物衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)15/56衛(wèi)氏并殖吸蟲(chóng)（肺吸蟲(chóng)）三、致病作用

1.致病機(jī)制

2.肺部基本病變：1）膿腫期2）囊腫期3）纖維瘢痕期3.其它組織器官病變：腹型、腦型、皮下型、肝型等4.臨床表現(xiàn)

衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)16/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)17/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)18/56腦型肺吸蟲(chóng)患者（偏癱）衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)19/56衛(wèi)氏并殖吸蟲(chóng)（肺吸蟲(chóng)）四、試驗(yàn)診療

1.病原學(xué)檢驗(yàn)：1）查蟲(chóng)卵2）查痰液3）皮下包塊活檢2.免疫學(xué)檢驗(yàn)1）皮內(nèi)試驗(yàn)2）間接血凝3）酶聯(lián)免疫吸附試驗(yàn)等衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)20/56衛(wèi)氏并殖吸蟲(chóng)（肺吸蟲(chóng)）五、流行

1.分布2.流行步驟1）有肺吸蟲(chóng)卵污染水源機(jī)會(huì)2）在同一個(gè)小溪內(nèi)必須有第一、二中間宿主并存。3）與飲食習(xí)慣相關(guān)

六、防治標(biāo)準(zhǔn)

衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)21/56斯氏貍殖吸蟲(chóng)（肺吸蟲(chóng)）衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)22/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)23/56斯氏貍殖吸蟲(chóng)（肺吸蟲(chóng)）主要特點(diǎn)

1.蟲(chóng)體兩端較尖，呈梭形2.終宿主為果子貍、犬等3.第一中間宿主為擬釘螺，第二中間宿主為溪蟹4.人為非正常宿主5.臨床表現(xiàn)以幼蟲(chóng)移行癥為主要特征皮膚型——皮下包塊腦型——腦膿腫、頭痛、癲癇等腹型——腹痛、腹瀉等6.診療時(shí)依皮下包塊活檢為主要依據(jù)

衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)24/56肺吸蟲(chóng)思索題1.描述衛(wèi)氏肺吸蟲(chóng)卵形態(tài)特點(diǎn)。2.衛(wèi)氏肺吸蟲(chóng)生活史特點(diǎn)是什么？3.衛(wèi)氏肺吸蟲(chóng)引發(fā)病理改變分——、——、——三期。4.查衛(wèi)氏肺吸蟲(chóng)卵可采集標(biāo)本有——、——。5.斯氏肺吸蟲(chóng)主要特點(diǎn)有哪些？衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)25/56教學(xué)課題：日本裂體吸蟲(chóng)

（血吸蟲(chóng)）教學(xué)目標(biāo)：

1.掌握血吸蟲(chóng)形態(tài)、生活史、致病作用2.熟悉血吸蟲(chóng)試驗(yàn)診療、流行及防治。教學(xué)重點(diǎn)：1.血吸蟲(chóng)卵、尾蚴2.生活史特點(diǎn)3.致病性教學(xué)難點(diǎn)：血吸蟲(chóng)致病性為難點(diǎn)，需要重點(diǎn)分析、了解、掌握。

衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)26/56日本裂體吸蟲(chóng)一、形態(tài)

成蟲(chóng)：雌雄異體，外形、生殖系統(tǒng)等。

衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)27/56活血吸蟲(chóng)衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)28/56活血吸蟲(chóng)雌雄合抱衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)29/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)30/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)31/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)32/56血吸蟲(chóng)活毛蚴衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)33/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)34/56血吸蟲(chóng)活尾蚴衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)35/56日本裂體吸蟲(chóng)卵口訣血吸蟲(chóng)卵黃色淡，小刺長(zhǎng)在殼一邊；“軍用水壺”是毛蚴，宿主組織殼外粘。衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)36/56二、生活史：1.發(fā)育過(guò)程1）在中間宿主體內(nèi)發(fā)育2）在終宿主體內(nèi)發(fā)育

衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)37/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)38/56血吸蟲(chóng)中間宿主活釘螺衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)39/56日本裂體吸蟲(chóng)（血吸蟲(chóng)）二、生活史

2.生活史特點(diǎn)1）成蟲(chóng)寄生部位—腸系膜下靜脈2）感染階段—尾蚴3）感染方式—經(jīng)皮膚4）宿主中間宿主—釘螺終宿主—人保蟲(chóng)宿主—牛（水牛）衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)40/56血吸蟲(chóng)保蟲(chóng)宿主（水牛）衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)41/56日本裂體吸蟲(chóng)（血吸蟲(chóng)）三、致病作用

1.尾蚴：尾蚴性皮炎2.童蟲(chóng)：呼吸道過(guò)敏反應(yīng)3.成蟲(chóng)：靜脈內(nèi)膜炎、靜脈周圍炎

衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)42/56日本裂體吸蟲(chóng)（血吸蟲(chóng)）三、致病作用

4.蟲(chóng)卵：是血吸蟲(chóng)主要致病階段。1）蟲(chóng)卵去向—沉積于肝臟沉積于腸壁隨糞便排出2）所致疾病—血吸蟲(chóng)病

衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)43/56日本裂體吸蟲(chóng)（血吸蟲(chóng)）三、致病作用血吸蟲(chóng)病

Ａ.致病機(jī)制：是以細(xì)胞免疫為基礎(chǔ)遲發(fā)型超敏反應(yīng)。Ｂ．臨床類型：ａ．急性血吸蟲(chóng)?。猓匝x(chóng)?。悖砥谘x(chóng)病衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)44/56血吸蟲(chóng)寄生于兔腸系膜靜脈衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)45/56血吸蟲(chóng)寄生于兔腸系膜靜脈衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)46/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)47/56兔血吸蟲(chóng)病肝、腸病變衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)48/56血吸蟲(chóng)肝臟病變嗜酸性肉芽腫衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)49/56衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)50/56一組血吸蟲(chóng)病人衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)51/56日本裂體吸蟲(chóng)（血吸蟲(chóng)）四、免疫特點(diǎn)：

1.伴隨免疫2.免疫逃避五、試驗(yàn)診療：1.病原學(xué)檢驗(yàn)a.糞便直接涂片法b.水洗沉淀法c.毛蚴孵化法d.腸粘膜活組織檢驗(yàn)2.免疫學(xué)診療a.環(huán)卵沉淀試驗(yàn)b.尾蚴膜試驗(yàn)c.間接血凝試驗(yàn)d.酶聯(lián)免疫吸附試驗(yàn)

衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)52/56日本裂體吸蟲(chóng)（血吸蟲(chóng)）六、流行1.分布：我國(guó)長(zhǎng)江領(lǐng)域及其以南十二個(gè)省、市。2.流行原因：社會(huì)原因、自然原因。3.流行步驟:1）傳染源：2）傳輸路徑：a.蟲(chóng)卵入水機(jī)會(huì)b.釘螺存在c.地理環(huán)境關(guān)系（平原水網(wǎng)型、山區(qū)丘陵型、湖沼型）

3）易感人群

衛(wèi)氏并殖吸蟲(chóng)肺吸蟲(chóng)53/56釘螺孳