Intestinal Flukes-Final

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警福隗
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1 Intestinal Flukes 腸吸蟲 Fasciolopesis buski 薑片蟲 Metagonimus yokogawi 橫川異形吸蟲 Heterophyes heterophyes 異形異形吸蟲 Echinostoma spp. 棘口吸蟲 Gastrodiscoides hominis 人雙口吸蟲

2 Main Clinical Features of Intestinal Flukes Infections Fasciolopsis buski Chronic diarrhoea 慢性腹瀉, preprandial pain, oedema of face and trunk 臉部水腫, malabsorption Heterophyes heterophyes Diarrhoea and preprandial pain Metagonimus yokogawa Ocassionally temporary abdominal pain and watery diarrhoea 水瀉 Gastrodiscoides hominis Mostly symptomless 無明顯症狀. Diarrhoea in heavy infections. Echinostoma spp. Mostly symptomless Heavy infections: diarrhoea, abdominal pain and eosinophilia

3 Fasciolopesis buski 薑片蟲

4 Fasciolopesis buski 薑片蟲 Fasciolopsiasis 薑片蟲症流行於遠東地區及東南亞 : 中國中部長江以南台灣泰國寮國越南高棉印尼印度及孟加拉

5 第一中間宿主淡水螺螄 (Freshwater planorbid snail) 第二中間宿主水生植物 ( 如菱角, 荸薺, 藕, 茭白筍等 ) 諸病源候論卷之十七痢病諸候[ 隋巢元方] 毒氣侵食受於臟腑,如病蠱注之家,痢血雜膿瘀黑,有片如雞肝,與血雜下是也中國大陸曾於兩具15 世紀的明代乾屍腸道中發現薑片蟲蟲卵

SNAILS WATER PLANTS Diagnostic stage 蟲卵 Unembryonated egg in faeces Cercaria 尾動幼蟲 Egg

6 Life Cycle of Fasciolopsis buski Excyst in duodenum Attaches to mucosa of small intestine 1~3 mths Adult in duodenum 成蟲囊狀幼蟲 Metacercaria on water plant Infective stage MAN (swine) SNAILS WATER PLANTS Diagnostic stage 蟲卵 Unembryonated egg in faeces Cercaria 尾動幼蟲 Egg embryonated in water 雷氏幼蟲 Redia in snail 胞子幼蟲 Sporocyst in snail 纖毛幼蟲 Miracidium penetrates snail

7 Fasciolopesis buski 薑片蟲成蟲形態特徵人體內最大的吸蟲 20~70 x 8~20 mm ( 平均 30 x 12 mm) 體表有小棘腹吸盤比口吸盤大倍盲腸沒有分枝分枝的睪丸佔蟲體後半部分枝的卵巢位於睪丸前方卵黃腺分佈在兩側食道生殖孔卵巢口吸盤咽腹吸盤陰莖囊子宮腸道卵殼腺勞氏管卵黃管輸出管睪丸卵黃腺

8 形狀大小頭錐腹吸盤腸分枝睪丸卵巢薑片蟲長而扁, 似薑片 20~75 x 8~20 不明顯比口吸盤大 4~6 倍在腹吸盤前分左右兩枝分枝較多, 佔後半的大部份分枝比睪丸少牛羊肝吸蟲較狹長 30~40 x 10~15 明顯稍大於口吸盤有很多側枝分枝多且細, 佔蟲體約一半分枝細

9 Clinical Features of Fasciolopsiasis Incubation period about 3 months. Infection die out within 6 mths Light infection Usually symptomless Heavy Infection <2000 eggs/ml The flukes inhabit in the duodenum and jejunum. <2,000~10,000 eggs/ml Medium infection The flukes inhabit in the duodenum and jejunum. 噁心嘔吐腹部隱痛或腹瀉等消化道症狀 >10,000 eggs/ml Flukes also found in the stomach, ileum and colon. Large number of worms cause intestinal obstruction 腸阻塞, Mechanical damage around attachment sites cause ulceration 潰瘍, inflammation 發炎, abscess 膿腫 and hypersecretion of the intestinal mucosa Toxic or allergic metabolites cause Generalized edema (anasarca) 全身性水腫 with ascites 腹水, most striking in the face 臉部水腫 Leukocytosis 淋巴球增生 and eosinophilia 嗜酸性白血球增加

10 Laboratory Diagnosis of Fasciolopsiasis 成蟲在人體內可生存約六個月, 每天產卵 15~25,000 個蟲卵形態特徵與牛羊肝吸蟲卵相似淡黃色, 卵圓形, 130~140 x 80~85 um, 人體中最大之寄生蟲卵卵殼薄而透明, 卵蓋較小且不明顯

11 Heterophyid Flukes 異形吸蟲 The smallest human parasitic flukes with an average length of 0.3~0.5 mm. Life span usually less than 2 months Heterophyes heterophyes 異形異形吸蟲 Metagonimus yokogawa 橫川異形 ( 後殖 ) 吸蟲 Haplorchis spp. 單睪吸蟲

12 Distribution 分佈 H. heterophyes 異形異形吸蟲流行於中東 ( 埃及以色列 ) 南歐 ( 羅馬尼亞希臘 ) 亞州 ( 中國中南部日本韓國菲律賓等 ) Egypt, Sudan, Palestine, Turkey, India, Middle East, Japan, Korea M. yokogawa 橫川異形吸蟲遠東西伯利亞巴爾幹半島諸國希臘西班牙亞州 ( 中國中南部日本韓國菲律賓等 ) Korea, Japan, China, Taiwan, Russia, India, Europe

13 Transmission 感染途徑食入未熟或醃魚身上之囊狀幼蟲而受感染 H. heterophyes 異形異形吸蟲第一中間宿主螺螄 Pirenella conica in the Nile Delta Cerithidea cingulata microptera in Japan and China 第二中間宿主魚類寄生部位小腸中段 (jejunum and upper jejunum) M. yokogawa 橫川異形吸蟲第一中間宿主螺螄第二中間宿主淡水魚類寄生部位空腸上中部, 但可見於十二指腸迴腸與盲腸

Life Cycle of Heterophid Flukes Excyst in

Metacercaria in fish Infective stage MAN SNAILS

Diagnostic stage 蟲卵 Embryonated egg in faeces

14 Life Cycle of Heterophid Flukes Excyst in duodenum Attaches to mucosa of small intestine 5~10 days M.y. 成蟲 Adults penetrates in mucosa 囊狀幼蟲 Metacercaria in fish Infective stage MAN SNAILS - FISHES H.h. Diagnostic stage 蟲卵 Embryonated egg in faeces 尾動幼蟲 Cercaria Egg ingested by snail and hatches inside the I.H. 雷氏幼蟲 Redia in snail 胞子幼蟲 Sporocyst in snail 纖毛幼蟲 Miracidium in snail

15 Heterophyes heterophyes 異形異形吸蟲成蟲形態特徵人體最小的吸蟲, 長寬約 1~1.7 x 0.3~0.4 mm 體表有鱗棘 (fish-scale like spines) 腹吸盤比口吸盤大, 均位於蟲體中線腹吸盤下側有一大型生殖吸盤一雙對稱並立的睪丸位於蟲體後半部卵巢位於睪丸前方, 卵黃腺很少且分佈在兩側後 1/3 口吸盤體棘腸道腹吸盤生殖吸盤子宮卵黃腺排泄囊睪丸

16 Metagonimus yokogawi 橫川氏腸吸蟲成蟲形態特徵與異形腸吸蟲接近但較大, 1~2.5 x 0.3~0.4 mm 無生殖吸盤, 腹吸盤位於中線右側兩個睪丸呈 45 o 弧線位於蟲體後端卵黃腺分佈在後 1/3 兩側口吸盤咽食道腸管腹吸盤儲精囊卵巢卵受精囊卵黃腺睪丸

17 口吸盤與腹吸盤生殖吸盤睪丸貯精囊異形異形吸蟲腹吸盤比口吸盤大位於中線 1/3 的前段腹側面位於腹吸盤左下方兩個彎曲橫川異形吸蟲腹吸盤比口吸盤大偏於中線右方無兩個彎曲

18 Haplorchis spp. 單睪吸蟲 Haplorchis taichui Haplorchis pumilio Haplorchis yokogawai

Extra-intestinal heterophyidiasis Minute

trapped in heart (cardiac failure), brain

19 Clinical Features 臨床徵候 Light Infections Mild intestinal disturbance 輕微腸胃腸不適 Heavy Infections Mucous diarrhoea 黏液性腹瀉絞痛腹部不適 ulceration of intestinal wall Extra-intestinal heterophyidiasis Minute eggs filter out to circulation Get trapped in heart (cardiac failure), brain (epilepsy) and the spinal cord (cerebospinal complications)

20 Laboratory Diagnosis 診斷鑑別糞便中的蟲卵異形異形吸蟲黃棕色至褐色, 23~30 x 14~17 um, 橢圓至卵形, 無肩峰, 卵蓋對側殼厚, 有小棘內含明顯之纖毛幼蟲橫川氏腸吸蟲黃褐色至褐色, 橢圓至卵形, 28~32 x 14~18 um, 卵殼厚, 表面不光滑, 內含不明顯之纖毛幼蟲

of the Philippines 1908 Fascioletta ilocanum 1933 Tubangui & Pasco described the life cycle - Euparyphium ilocanum Human

21 Echinostomatidae 棘口吸蟲科 Intestinal parasitic fukes in many kinds of vertebrates, particularly aquatic birds. Echinostoma (Euparyphium) ilocanum 1907 Garrison found eggs in the faeces of prisoners in manila from the Ilocano region of the Philippines 1908 Fascioletta ilocanum 1933 Tubangui & Pasco described the life cycle - Euparyphium ilocanum Human cases have been reported from the Philippines - Manila, Cagayan Valley, Zambales & Luzon Indonesia - Celebes & Java Thailand and China

22 Echinostoma ilocanum 伊羅棘口吸蟲口吸盤腹吸盤 Crcumoral disc 圍口盤子宮卵黃腺卵巢睪丸成蟲形態特徵長寬約 2.5~6.5 x 1~1.35 mm 腹吸盤比口吸盤大 3~4 倍頭部有二列頭棘, 體表有皮棘 (spines) 二個睪丸前後排列於蟲體後端卵黃腺分佈蟲體後 2/3 兩側

23 Life Cycle of Echinostoma ilocanum Infective stage snail, aquatic plant, insects, frogs & fishes Cercaria Metacercaria Daughter redia 2 nd IH Final host Adults in small intestine Eggs in feaces Miracidium Snail host 8 days 3 days Mother redia Sporocyst 6 days 1 st IH Diagnostic stage 3 wks Gyranulus Planorbis Hippeutis Lymnaea

24 Life Cycle of Echinostoma ilocanum Excyst in duodenum Attaches to mucosa of small intestine 成蟲 Adult in duodenum 囊狀幼蟲 Infective stage MAN Diagnostic stage 蟲卵 Metacercaria in fish snails or tadpoles SNAILS FISHES Unembryonated egg in faeces 尾動幼蟲 Cercaria Egg embryonated in water 雷氏幼蟲 Redia in snail 胞子幼蟲 Sporocyst in snail 纖毛幼蟲 Miracidium penetrates snail

25 Clinical Features 臨床徵候 Light Infections Usually symptomless Minor abdominal distrubances: flatulence 腸胃脹氣, diarrhea 腹瀉 or constipation 便秘 Heavy infections The flukes parasitic deep between villi and release toxic metabolites mild catarrhal inflammation of the intestinal mucosa 刺激腸黏膜造成發炎潰瘍 Generalizeed toxic processes headache, dizziness and slight anemia

26 Laboratory Diagnosis 診斷鑑別糞便中的蟲卵伊羅棘口吸蟲蟲卵形態特徵形態接近薑片蟲卵淡黃色, 橢圓或卵圓形, 81~116 x 53~82 µm, 卵殼薄, 卵蓋對側端略增厚, 內含一個卵細胞和許多卵黃細胞

$S:Disc; EIDOS:Like\Similar Amphistomum hominis 人雙口吸蟲 J.J.C.$

27 Gastrodiscoides hominis 人腹盤吸蟲 GASTER :Belly ; DISCOS:Disc; EIDOS:Like\Similar Amphistomum hominis 人雙口吸蟲 J.J.C. Buckley found in 1939 that three villages surveyed in Assam over 40% of the population was infected. Distribution Malaysia, Assam, India, Burma, South Vietnam and Guyana.

28 Gastrodiscoides hominis 人雙口吸蟲 Oral sucker 口吸盤 Pharynegal pouch 咽囊 caeca 肓腸成蟲形態特徵紅棕色, 表皮光滑, 蟲體呈角錐形長寬約 5~7 x 3~4 mm 口吸盤小, 呈球狀腹吸盤接近口吸盤有一明顯凹陷及背面突起睪丸大分葉前後排列 acetabulum 基部臼 ( 腹吸盤 )

Life cycle of Gastrodiscoides hominis Excyst in duodenum Attaches to caecum and ascending colon with acetabulum 成蟲 Cause imflammation of mucosa and persistent diarrhea with mucous discharge 囊狀幼蟲

29 Life cycle of Gastrodiscoides hominis Excyst in duodenum Attaches to caecum and ascending colon with acetabulum 成蟲 Cause imflammation of mucosa and persistent diarrhea with mucous discharge 囊狀幼蟲 Metacercaria in water plants Infective stage PIG & DEER FRESH WATER SNAILS Diagnostic stage 蟲卵 Egg in faeces 尾動幼蟲 Cercaria Redia 雷氏幼蟲胞子幼蟲 Sporocyst 纖毛幼蟲 Miracidum penetrates snail Egg embryonates in water or ingested by snail

30 Clinical Features 臨床徵候 While this parasite is typical found in pigs, it can also affect humans. Usually the infection is asymptomatic but occasionally it can also cause intestinal problems such as diarrhea, fever, abdominal pain, colic, and an increase in mucous production. In severe cases, where there may be large amounts of eggs present, tissue reactions can occur in the heart or mesenteric lymphatics.

31 Gastrodiscoides hominis 人雙口吸蟲蟲卵形態特徵形態接近薑片蟲卵淡黃色, 卵圓形, 前端狹窄 145~170 x 60~75 um, 卵蓋細小卵排出時未發育成胚 ( 內含一個卵細胞和許多卵黃細胞 ) G. hominis egg F. buski egg

Microsoft PowerPoint - Diseases of gastrointestinal system (教材審查) [相容模式]

Microsoft PowerPoint - Diseases of gastrointestinal system (教材審查) [相容模式] Disease of Gastrointestinal System 消化道疾病病理學科方嘉郎 [email protected] 消化器官腸胃道 (gastrointestinal tract): 口腔 (oral cavity) 食道 (esophagus) 胃 (stomach) 小腸 (small intestine) 大腸 (large intestine)