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            <h1 id="seo-header">【迁移】寄生虫三：医学蠕虫之绦虫</h1>
            
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                    Last updated on March 19, 2024 pm
                  
                
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            <p><a href="https://hexo.limour.top/go/#aHR0cHM6Ly9jb2RlYmVhdXRpZnkub3JnL2h0bWwtdG8tbWFya2Rvd24=" rel="noopener external nofollow noreferrer">Code Beautify</a> 从 wordpress 自动转换而来，可能存在格式错误。</p>
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<p>绦虫属于扁形动物门，多数寄生于脊椎动物的消化道，幼虫寄生于中间宿主（包括人体）各种组织内。无口及消化道，无体腔，绝大多数雌雄同体。</p>
<p><img src="https://img.limour.top/2023/09/01/64f0bd66450f1.webp" srcset="https://jscdn.limour.top/gh/Limour-dev/Sakurairo_Vision/load_svg/inload.svg" lazyload alt=""></p>
<h2 id="裂头蚴-曼氏迭宫绦虫">裂头蚴/曼氏迭宫绦虫</h2>
<p>人并非本虫的适宜终宿主。感染主要是由于体表局部敷贴生蛙肉、吞食生的蛙、蛇、鸡或猪肉，误食感染的剑水蚤等。</p>
<p>成虫子宫位于节片中部，螺旋状盘曲，紧密重叠（迭宫）。终宿主是猫、犬及其他食肉动物，第一中间宿主是剑水蚤，第二中间宿主是蛙，蛇、鸟、猪等可作为转续宿主，人可作为第二中间宿主、转续宿主和终宿主。</p>
<p>裂头蚴病比成虫致病常见且严重。裂头蚴在移行或寄居部位形成囊腔、穴道和嗜酸性肉芽肿囊包，使局部肿胀、甚至发生脓肿。当寄生于皮下肌肉、口腔颌面或外眼等器官时，主要表现为游走性皮下结节或肿块，病人有疼痛以及虫爬感和小白虫逸出史等。寄生于脑、脊髓或眼球深部组织时则主要表现为压迫以及占位性病变，如癫痫、瘫痪、视力障碍。成虫感染则是中、上腹不适，隐痛、恶心呕吐等。</p>
<p>诊断成虫检查粪便虫卵、裂头蚴病局部组织检出虫体、影像学和免疫学辅助检查。</p>
<p>成虫感染口服吡喹酮、阿苯达唑。裂头蚴靠手术摘除，或用40%酒精普鲁卡因2~4ml局部注射杀虫。</p>
<h2 id="带绦虫-链状带绦虫和肥胖带绦虫">带绦虫/链状带绦虫和肥胖带绦虫</h2>
<p>人是唯一的终宿主。猪带绦虫：误食囊蚴得猪带绦虫病，误食虫卵得囊尾蚴病，有自体感染、自体外感染、异体感染。牛带绦虫：误食含有活囊尾蚴的牛肉。</p>
<p>成虫主要寄生在小肠，孕节脱落，随粪便排出，孕节被人食入得囊虫病，被猪食入，在十二指肠孵出六钩蚴，钻入肠壁，血管移行、肺、左心、全身各组织形成囊尾蚴，被人食入，在十二指肠胆汁刺激下翻出头节，以吸盘和小钩附着于肠黏膜上，发育为成虫。</p>
<p>成虫寄生在小肠引起绦虫病。牛带绦虫的囊尾蚴不寄生人体，牛是唯一的中间宿主。猪带绦虫则引起皮下肌肉囊虫病、眼囊虫病、脑囊虫病。</p>
<p>诊断找孕节，数分支，猪带绦虫每侧分支7~13支，牛带绦虫每侧15~30支。猪带绦虫也可以粪便饱和盐水漂浮法或直接涂片法。皮下肌肉可以活检，脑可以影像学和免疫检查，眼可以眼底镜检查。</p>
<p>中药驱虫安全可靠，成功标准是排出头节。用南瓜子和槟榔煎剂。确定没有脑囊虫，可以用吡喹酮、阿苯达唑、甲苯达唑。</p>
<h2 id="包虫-细粒棘球绦虫">包虫/细粒棘球绦虫</h2>
<p>成虫寄生于犬科动物的肠道内，幼虫寄生于食草动物和人的组织、脏器中。引起囊性包虫病。</p>
<p>犬科动物的小肠内的孕节脱落，随粪便排出，卵被食草动物或人食入，在十二指肠孵出六钩蚴，钻入肠壁，经血管移行，幼虫依次在肝、肺、腹腔、脑、脾、肾、骨、子宫、眼等器官，形成棘球蚴，牛羊被犬吞食后，囊内原头蚴在胆汁刺激下翻出顶突，附着小肠壁，逐渐发育为成虫。</p>
<p>棘球蚴囊占位压迫，肺/颅脑/骨等囊型棘球蚴病。囊破裂会发生继发感染和种植性生长。</p>
<p>诊断禁忌穿刺，依据手术取出的棘球蚴，或痰、胸膜积液、腹水、尿液中拣获的棘球蚴碎片或原头蚴。或影像学、免疫学检查。</p>
<p>治疗以外科手术为主，对早期的小棘球蚴，可口服阿苯达、吡喹酮、甲苯达唑。</p>
<h2 id="泡球蚴-多房棘球蚴">泡球蚴/多房棘球蚴</h2>
<p>从事猎狐、饲养狐和加工、买卖毛皮制品等生产活动的人群尤其易感。引起泡球蚴，呈弥漫型浸润，有“虫癌”之称。</p>
<p>人是多房棘球绦虫的非适宜中间宿主，人体感染囊泡内含胶状物而无原头蚴。常见终宿主为犬科动物，偶尔可寄生猫体内。中间宿主为啮齿动物、耗牛、绵羊和人等。成虫寄生在终宿主小肠，孕节和虫卵随粪便排出，鼠类等因觅食终宿主粪便而感染，人因误食虫卵而感染。体内带有泡球蚴的鼠或动物内脏被终宿主吞食后，囊内原头蚴逸出，经45天发育为成虫。</p>
<p>泡球蚴危害严重，病死率高。泡球蚴几乎原发于肝脏，弥漫性浸润，波及整个器官。除肝脏外，肺、脑等经肝血液继发感染转移过来。皮下、脾、膀胱等都可被寄生。</p>
<p>适用于棘球蚴的诊断，免疫诊断效果尤佳。</p>
<p>治疗以手术为主，药物用阿苯达唑、甲苯达唑和吡喹酮。</p>

                
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