-yi-xue-ru-chong-zhi-xian-chong.html 30 KB

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  166. <h1 id="seo-header">【迁移】寄生虫一:医学蠕虫之线虫</h1>
  167. <p id="updated-time" class="note note-info" style="">
  168. Last updated on March 19, 2024 pm
  169. </p>
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  171. <div class="note note-info">
  172. <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>
  173. </div>
  174. <p>线虫一般呈线性或圆柱形,体表光滑,两侧对称,不分节。前端一般较钝圆,后端逐渐变细。线虫雌雄异体,通常雌虫较大,尾端尖直,略向腹面弯曲,生殖器官大多为双管型;雌虫较小,尾端卷曲呈钩状或尾端膨大呈伞状,生殖器官呈单管型。线虫卵一般为椭圆形,黄色、棕黄色或无色。卵壳由外层的卵黄膜(或受精膜)、中层的壳制层和内层的蛔苷层(或脂层)三层结构组成。</p>
  175. <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>
  176. <h2 id="蛔虫-似蚓蛔线虫">蛔虫/似蚓蛔线虫</h2>
  177. <p>人是唯一宿主。蛔虫是人体最大的肠道线虫,主要在温暖潮湿的地区流行,农村感染率高于城市,温暖潮湿地区高于寒冷干燥地区。</p>
  178. <p>成虫雌雄异体,生活在人体小肠,寿命一年,有肛门开口,口孔位于虫体顶端,周围有三个唇瓣,排列成品字形。排出到外界的虫卵,如果受精,会在卵内发育成幼虫,卵内幼虫蜕一次皮后,虫卵成为感染期卵,被人误食后在小肠孵出幼虫,侵入肠黏膜和黏膜下层,进入静脉或淋巴管,先后经肝、右心、到达肺,穿破肺毛细血管进入肺泡,沿支气管、气管逆行至咽部,随吞咽动作再次进入消化道,最后在小肠内发育为成虫。</p>
  179. <p>蛔虫的幼虫移行阶段可引起蛔虫性肺炎或蛔虫性哮喘,经过肝脏时可以引起轻微的炎症,但主要的还是成虫致病。胆道蛔虫症、蛔虫性胰腺炎、蛔虫性阑尾炎,蛔虫性肠梗阻可进一步发展成肠扭转、肠套叠、肠坏死。其中胆道蛔虫症最常见,可引起梗阻性胆管炎和肝脓肿。</p>
  180. <p>蛔虫幼虫致病时,患者可发烧、干咳、哮喘、胸痛、咯血、荨麻诊,肺部散在游走性片状阴影。外周血中嗜酸性粒细胞增多,称为 Loeffler’s 综合征。多数病例两周内自愈。</p>
  181. <p>成虫致病,常有腹部不适或间歇性脐周疼痛。代谢产物和排泄物引起毒性和变态反应,出现食欲不振、恶心、烦躁、夜间磨牙、瘙痒、荨麻诊、哮喘,甚至出现中毒性脑病,儿童偶有异嗜症。</p>
  182. <p>生理盐水直接涂片法是首选的诊断方法,三片检出率可达95%。饱和盐水漂浮法或粪便沉淀法可以提高虫卵检出率。对于蛔蚴性肺炎,可以痰液涂片。</p>
  183. <p>常用驱虫药有阿苯达唑、甲苯达唑、三苯双脒和伊维菌素。</p>
  184. <h2 id="鞭虫-毛首鞭形线虫">鞭虫/毛首鞭形线虫</h2>
  185. <p>人是唯一宿主。主要流行在热带、亚热带发展中国家和地区。农村感染率高于城市。</p>
  186. <p>鞭虫因形似马鞭而得名,虫卵两端各有一个透明栓。成虫一般寄生在盲肠,寿命3~5年,严重时可寄生于结肠、直肠甚至回肠下端,排出到外界的虫卵经三周发育为含有幼虫的感染期卵。经口食入后在小肠内孵出,仅钻入小肠上皮,10天后回到肠腔,移行至盲肠发育为成虫。</p>
  187. <p>幼虫侵入肠壁有轻微炎症但常无自觉症状。成虫有机械性损伤和代谢产物刺激,引起肠黏膜出血、炎症和溃疡,长期慢性炎症可以引起肉芽肿。表现为腹部不适、腹痛、腹泻、贫血、心慌、脱肛。</p>
  188. <p>首选饱和盐水漂浮法,也可以用直接涂片法、改良加藤厚涂片法。(光)纤维结肠镜检查发现虫体。</p>
  189. <p>常用驱虫药有阿苯达唑、甲苯达唑、奥克太尔。</p>
  190. <h2 id="蛲虫-蠕形住肠线虫">蛲虫/蠕形住肠线虫</h2>
  191. <p>人是唯一宿主。可经空气传播,感染率儿童高于成人,幼儿园感染率高,有家庭聚集性。</p>
  192. <p>蛲虫前端角皮膨大形成头翼,咽管末端肌肉发达形成咽管球。卵内含一胚胎。成虫常寄生在盲肠,因肠腔低氧,雌虫几乎不产卵。宿主入睡后。受孕雌虫移行至肛门外,虫卵产在肛周,卵内幼虫经6小时发育为感染期卵。经手-口或空气吸入的卵,在十二指肠孵出,沿小肠下行。肛门处孵化的幼虫也可逆行感染。</p>
  193. <p>肛周产卵引起瘙痒,患者常有烦躁、失眠、食欲缺乏、消瘦、夜间磨牙、夜惊、学习成绩下降。挠痒抓破皮肤可继发感染。吸入的虫卵可引起哮喘。</p>
  194. <p>首选透明胶纸法进行检查。也可以用肛门拭子法和肛周找虫法。</p>
  195. <p>常用阿苯达唑和甲苯达唑治疗。局部外用3%噻嘧啶软膏。</p>
  196. <h2 id="钩虫-十二指肠钩口线虫和美洲板口线虫">钩虫/十二指肠钩口线虫和美洲板口线虫</h2>
  197. <p>人是唯一宿主。含虫卵的粪便污染土壤,田间劳作时裸露的皮肤接触疫土。主要流行在黄河以南的广大农村地区。</p>
  198. <p>十二指肠钩口线虫呈C形,美洲板口线虫呈S形,口囊内钩齿或板齿。钩虫卵壳薄,内有卵细胞,间隙明显。成虫咬附小肠黏膜,以血液和淋巴液为食。排出到外界的虫卵经1~2天孵出杆状蚴,再经一周发育成具有感染能力的丝状蚴。丝状蚴钻入皮肤,经小静脉或淋巴管进入右心、肺,穿过肺毛细血管进入肺泡、支气管、气管,在咽部随吞咽进入小肠,蜕皮后发育为成虫。</p>
  199. <p>幼虫可以引起钩蚴性皮炎,移行到肺部引起 Loeffler’s 综合征。成虫吸取血液,分泌抗凝物质,使伤口长时间渗血。丢失大量血红蛋白,损失的铁无法得到补充,小细胞低色素性贫血。损失肠黏膜,可出现上腹部疼痛或腹泻。缺铁引起异嗜症。此外,十二指肠钩虫也可以经口感染,钩蚴也可以经过胎盘或母乳感染胎儿或婴儿。</p>
  200. <p>优选饱和盐水漂浮法。感染严重时可以直接涂片法。钩蚴培养法也行。</p>
  201. <p>常用阿苯达唑、甲苯达唑、噻嘧啶,驱虫时需要补充铁剂。</p>
  202. <h2 id="旋毛虫-旋毛形线虫">旋毛虫/旋毛形线虫</h2>
  203. <p><img src="https://img.limour.top/2023/09/01/64f0bd802b0e9.webp" srcset="https://jscdn.limour.top/gh/Limour-dev/Sakurairo_Vision/load_svg/inload.svg" lazyload alt=""></p>
  204. <p>除人外,许多哺乳动物如猪、老鼠、犬、野生动物等均可作为保虫宿主。旋毛虫是寄生人体最小的线虫。流行具有地方性、群体性和食源性。</p>
  205. <p>成虫主要寄生在十二指肠和空肠上段,雌雄交配产生幼虫,幼虫侵入局部淋巴管或小静脉,抵达骨骼肌进一步发育,刺激肌细胞形成囊包。囊包幼虫为感染期,需要转换新的宿主才能完成生活史,否则大部分在半年后钙化。</p>
  206. <p>侵入时在十二指肠和空肠产生广泛性肠炎,恶心、呕吐、腹痛、腹泻,伴有厌食、乏力、畏寒、低热,持续一周,易误诊。幼虫进入肌肉时,有全身中毒、过敏症状,血管炎、肌炎,眼睑和面部水肿,可因心衰、呼吸道并发症死亡。</p>
  207. <p>常用活检法,取腓肠肌或肱二头肌进行活检。收取吃剩的猪肉也可作为佐证。免疫诊断常用ELISA法,敏感性高、特异性强,适用于急性期病人的早期诊断。</p>
  208. <p>阿苯达唑是首选药,能杀死肌肉中的幼虫。感染一周内用药,治愈率可达100%。</p>
  209. <h2 id="丝虫-班氏吴策线虫和马来布鲁线虫">丝虫/班氏吴策线虫和马来布鲁线虫</h2>
  210. <table>
  211. <thead>
  212. <tr>
  213. <th></th>
  214. <th>班氏微丝蚴</th>
  215. <th>马来微丝蚴</th>
  216. </tr>
  217. </thead>
  218. <tbody>
  219. <tr>
  220. <td>大小</td>
  221. <td>大</td>
  222. <td>小</td>
  223. </tr>
  224. <tr>
  225. <td>体态</td>
  226. <td>自然</td>
  227. <td>僵硬</td>
  228. </tr>
  229. <tr>
  230. <td>头间隙</td>
  231. <td>短</td>
  232. <td>长</td>
  233. </tr>
  234. <tr>
  235. <td>体核</td>
  236. <td>圆、清晰</td>
  237. <td>椭圆、重叠</td>
  238. </tr>
  239. <tr>
  240. <td>尾核</td>
  241. <td>无</td>
  242. <td>2个</td>
  243. </tr>
  244. </tbody>
  245. </table>
  246. <p>人是终宿主、蚊是中间宿主。经蚊虫叮咬传播。</p>
  247. <p>成虫寄生在淋巴管内。微丝蚴白天聚集在肺部的毛细血管中,夜晚进入外周血液中。经蚊虫吸入后,发育成腊肠期幼虫、感染期幼虫(丝状蚴),叮咬人后进入人体。</p>
  248. <p>微丝蚴血症,仅有发热和淋巴管炎症状,可持续10年以上。幼虫和成虫的分泌排泄裂解物刺激,出现淋巴管/结炎、精索炎、附睾炎、睾丸炎,慢性期发生淋巴阻塞,淋巴水肿和象皮肿、鞘膜积液、乳糜尿。</p>
  249. <p>夜间取血检查微丝蚴,首选厚血膜法,尿液和体液中也可检查微丝蚴。免疫学可以皮内试验或检测抗体和循环抗原。</p>
  250. <p>治疗用海群生(乙胺嗪)、呋喃嘧酮、阿苯达唑、伊维菌素。保泰松治疗急性淋巴管炎。</p>
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  262. <div>【迁移】寄生虫一:医学蠕虫之线虫</div>
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