Blood flukes Intestinal flukes - med.cmu.ac.th€¦ · INTESTINAL FLUKES Approximately 40 species...

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Dr. Anuluck Junkum PARA 317331 Blood flukes Intestinal flukes

Transcript of Blood flukes Intestinal flukes - med.cmu.ac.th€¦ · INTESTINAL FLUKES Approximately 40 species...

Page 1: Blood flukes Intestinal flukes - med.cmu.ac.th€¦ · INTESTINAL FLUKES Approximately 40 species were reported in Thailand 50 million people are infected Most of intestinal flukes

Dr. Anuluck JunkumPARA 317331

Blood flukesIntestinal flukes

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รและอธบายเกยวกบพยาธใบไมล าไสและพยาธใบไมเลอด

วตถประสงค

ทมความส าคญทางการแพทยและท าใหเกดโรคในคนได

• ชนด ( S p e c i e s ) และทอยอาศย

• รปรางลกษณะ

• วงจรชวต

• การกอโรคและการตรวจวนจฉยโรค

• การรกษาและการควบคมปองกน

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FLUKES: Habitat (organs of host)

1. Lung fluke

2. Liver fluke

3. Intestinal fluke

4. Blood fluke

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INTESTINAL FLUKES

Approximately 40 species were reported in Thailand

50 million people are infected Most of intestinal flukes live in

small intestine

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I. Large intestinal flukes

II. Minute intestinal flukes

(Intestinal flukes)พยาธใบไมล าไส

• Family Fasciolidae• Family Paramphistomatidae• Family Echinostomatidae

• Family Heterophyidae• Family Lecithodendriidae

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Large intestinal flukes

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Family: FasciolidaeGenus Species

•Fasciola - F. gigantica- F. hepatica

•Fasciolopsis F. buski

F. buski

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Genus•Fasciola

•Fasciolopsis

F. buski

- F. gigantica- F. hepatica

: F. buski

Intestinal fluke

FasciolidaeFamily

F. gigantica

Liver fluke

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Differentiation F. buskiF. gigantica1. Oral sucker : Ventral sucker2. Cephalic cone3. Intestine4. Ovary (location)5. Testes

1 : 3 1 : 4-6+ -

branch unbranch caeca1/4 middle

overlap separateOral sucker : Ventral sucker

Cephalic coneOvary

Testes

Intestine

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Genus Species

Gastrodiscoides G. hominis

G. hominis

Family: Paramphistomatidae

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Family: Echinostomatidae

Genus Species

•Echinostoma - E. malayanum- E. ilocanum- E. revolutum

•Hypoderaeum H. conoideum

E. malayanum

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Family

Genus

•Echinostoma

•Hypoderaeum

- E. malayanum- E. ilocanum- E. revolutum

: H. conoideum

Echinostomatidae

H. conoideum E. malayanum

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Minute intestinal flukes

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Family: Heterophyidae

Genus Species

•Heterophyes H. heterophyes

•Metagonimus M. yokogawai

•Haplorchis H. taichui

H. heterophyes

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Family: Heterophyidae

H. taichui M. yokogawai H. heterophyes

Genus: Haplorchis Metagonimus Heterophyes

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Family: Lecithodendriidae

Genus Species

•Phaneropsolus P. bonnei

•Prosthodendrium P. molenkampi

P. bonnei

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Family

Genus

•Phaneropsolus

•Prosthodendrium

: P. bonnei

: P. molenkampi

Lecithodendriidae

P. molenkampi P. bonnei

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Intestinal flukesLarge intestinal flukes Minute intestinal flukes

Haplorchis taichuiFasciolopsis buski

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พยาธใบไมล าไสขนาดใหญFasciolopsis buski

อณฑะ

รงไข

Fasciolopsis buski

• ขนาดใหญ ล าตวแบน

• ผวหนงมหนามเลกๆ รอบตว• ล าไส: 2 ทอ • มอณฑะเปนแขนงยอย 1 ค• มรงไขเปนแขนงยอย 1 อน

รปรางลกษณะพยาธตวแก

• หวไมมสวนยนออกมา

ล าไส

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6 Cm

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รปรางลกษณะไข

• รปรางกลมรคลายไขไก• ขนาดใหญ (80-85 x 130-140 um)

• เปลอกบางสเหลองปนน าตาล• มฝาเลก ๆ เหนไมชด• ภายในไขเปน Yolk cell

: คลายไขพยาธใบไมตบ (Fasciola gigantica)

Fasciola & Fasciolopsis spp.

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Fasciolopsis buski

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Intermediate host 1หอยน าจดตวเลก (Segmentina spp.)

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Intermediate host 2พชน า

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FasciolopsiasisInfection : 10 million/year

China, Taiwan, Loas, Vietnam,

Thailand, Cambodia, Indonesia

Malaysia, Korea, India

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Attachment of large worms to the mucosal of bowel

The large size and heavy infection

“intestinal obstruction”

Inflammation of mucosa

Ulceration

Haemorrhage

Pathology & Symptom

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Heavy infection (100-10,000 worms)

- intestinal edema (absorption of worm toxins)

- abdominal pain, chronic diarrhea- The stool contain much undigested food- Vit B12 absorption

- allergy

Pathology & Symptom

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• โรค: โรคพยาธใบไมล าไส (Fasciolopsiasis)

• การตดตอ: กนพชน าดบทมระยะตดตอ

• การกอโรค: ปวดทอง คลนไสอาเจยน บวม

• การวนจฉย: ตรวจอจจาระหาไขพยาธ

• การรกษา: Praziquantel (15 mg/kg)

• การปองกน: ไมกนพชน าดบ & ถายอจจาระลงสวม

Fasciolopsis buski

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Haplorchis taichui

Minute Intestinal flukes

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Haplorchis taichuiพยาธใบไมล าไสขนาดเลก

อณฑะ

รงไข

Haplorchis taichui

• ขนาดเลก รปรางเหมอนใบไม

• ล าไสแยกเปนสองแขนง

• ล าตวทางดานบนมหนามเลกๆ

รปรางลกษณะพยาธตวแก

• Ventral sucker มหนามเรยงรปพด

• มอณฑะเปนกอนกลมใหญ 1 กอน

• มรงไขเปนกอนกลม 1 กอน

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Ventral sucker

egg

fan shaped with 13-16 hooklets

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รปรางลกษณะไข: คลายไขพยาธใบไมตบ (Opisthorchis viverrini)

• รปรางรคลายหลอดไฟฟา

• ขนาดเลก (13 x 27 um)

• สเหลองออน มฝา และไหล

• ดานตรงขามฝามปม

• ภายในไขมไมราซเดยม

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วงจรชวต:

- โฮสตสอกลางตวท 1: หอยน าจด (cercaria)

- โฮสตเฉพาะ: คน สนข แมว

- โฮสตสอกลางตวท 2: ปลาน ากรอย (metacercaria)

- ระยะตดตอ: เมตาเซอรคาเรย

Haplorchis taichui

Cercaria

Metacercaria

Miracidium

Egg

Definitive host

Intermediate host 1Intermediate host 1Sporocyst

Intermediate host 1

CercariaRedia

Adult

Intermediate host 2

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Intermediate host 1หอยเจดย (Melanoides tuberculata)

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Intermediate host 2ปลาตะเพยน (Cyprinoid fish)

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• Inflammation• Sloughing and necrosis of mucosa• Eosinophil and neutrophils infiltration• Mucoid diarrhea• Upper abdominal discomfort• Colicky pain & gurgling abdomen• Extraintestinal lesion (heart, brain, spinal cord)

Pathology & Symptom

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Haplorchis taichui

• โรค:• การตดตอ: กนปลาดบทมระยะตดตอ

• การกอโรค:• การวนจฉย: ตรวจอจจาระหาไขพยาธ

• การรกษา: Praziquantel (15-25 mg/kg)

• การปองกน: ไมกนปลาดบ & ถายอจจาระลงสวม

ผนงล าไสอกเสบ ปวดทอง ทองเดนเรอรง

โรคพยาธใบไมล าไส (Haplorchiasis)

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Papaya Salad

Preserved fishPickled crab

Water plant

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Blood fluke

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พยาธใบไมเลอด

1. Schistosoma mansoni South America

2. S. haematobium Africa

3. S. japonicum* SEA

4. S. mekongi* SEA

(Blood flukes : Schistosome)

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ลกษณะแตกตาง :

เพศแยกกน

เซอรคาเรย

1. พยาธตวแก :

2. ไข :

3. ระยะตดตอ : (= IH2)

ไมมฝา

พยาธใบไมเลอด

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พยาธใบไมเลอด (Schistosoma spp.)

testes ovary

ลกษณะโดยทว ๆ ไป

พยาธตวแกมเพศแยกกน

ตวผมรอง (gynaecophoric canal) ใหตวเมยเขาไปอาศยอย

ตวผมอณฑะหลายกอน

มล าไสแยกเปน 2 อนแลวมา รวมกนเปนอนเดยว

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รปรางลกษณะพยาธตวแก

- มรองกลางล าตว: - รปรางเหมอนพยาธใบไมทวไป

(gynaecophoric canal)

: - มรปรางเรยวยาว อาศยอยในรองตวผ

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รปรางลกษณะไข

• รปรางร มหนาม 1 อน

• มไมราซเดยมอยภายใน

S. japonicum S. mansoni S. haematobium

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20-100

Cuticle

S. haematobium S. mansoni S. japonicum

Small tubercle Spine large tubercle

Smooth

No. of Testes*** 4-5 (กลม) 6-9 (กลม) 6-8 (7) (เรยงเดยว)

Ovary*** Posterior of the body

Anterior of the body

Middle of the body

Eggs in uterus 2-3 Up to 300

Eggs*** Oval, Spine at one end

Oval, Spine at one side

Round, Knob at one side

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AdultHabitat

S. haematobium S. mansoni S. japonicum

Venous plexus of urinary bladder and rectum

Inferior Mesenteric vein

Superior Mesenteric vein

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Cercaria(Lung F, Liver F, Intestinal F)

Fork-tailed cercaria(Blood flukes)

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Schistosoma mansoni (large intestine)

S. haematobium (urinary bladder)

S. japonicum (small intestine)

S. mekongi (small intestine)

Intestinal schistosomiasis

Urinary schistosomiasis

Diseases

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อาการ และ อาการแสดง

ระยะ cercaria ไชเขาทางผวหนง: ผวหนงอกเสบ (dermatitis)

: คน (Itching) & บวม (edema)

: ผน ลมพษ (Urticarial rash)

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ระยะ cercaria เดนทางไปปอด ตบ:: มไข, ปวดหว, เวยนหว, เบออาหาร, เมดเลอดขาวชนด eosiophil สง

ระยะตวแกวางไข:: อจจาระและปสสาวะเปนเลอด ตบโตมามโตเนองจากมไขของพยาธ

แทรกเขาไปเนอเยอของตบและมามท าใหเกดการอกเสบและมฝเกดขน

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ระยะซอมแซม (ระยะรนแรง)

ตบ: มขนาดเลกลง เพราะถกแทนทดวยเนอเยอทถกสรางขนใหม (fibrosis)

ท าใหผปวยเกดโรคตบแขงได

: เกดกอนทบรเวณล าไส ตบ มาม

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Central nervous system lesions occur:

1. Cerebral granulomatous disease

: ectopic S. japonicum eggs in brain

2. Granulomatous lesions around ectopic

eggs in the spinal cord

: S. mansoni & S. haematobium

Occasionally

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Granulomatous reactions and fibrosis in

the affected organs

Colonic polyposis with bloody diarrhea

: S. mansoni (mostly)

Portal hypertension and splenomegaly

: S. mansoni, S. japonicum

Cystitis and ureteritis with hematuria

: can progress to bladder cancer: S. haematobium

Pulmonary hypertension

: S. mansoni & S. japonicum

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1. ตรวจอจจาระหรอปสสาวะหาไขพยาธ

การตรวจวนจฉย

2. ตรวจชนเนอ

3. ตรวจเลอด

ไขพยาธ

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Schistosome cercarial dermatitis

Skin penetration by animal cercaria

Animal Schistosome

Severe rash

(Swimmer’s itch)

- S. incognitum (pig & dog)

- S. spindale (cattle)

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(Swimmer’s itch)

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หลกเลยงเขาไปในแหลงระบาด

รกษาผปวยทนทเพอปองกนการระบาด

ก าจดหอยทเปนโฮสตสอกลางตวท 1

ใหการศกษาเรองโรคพยาธใบไมเลอด

การปองกน

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พยาธใบไมเลอด(Blood flukes : Schistosome)

• โรค โรคพยาธใบไมเลอด (Schistosomiasis)

• การตดตอ ระยะ cercaria ไชเขาทางผวหนง

• การกอโรค

• การวนจฉย ตรวจหาไขพยาธ

• การรกษา Praziquantel (60 mg/kg)

• การปองกน ไมเลนน าบรเวณทมพยาธระบาด

มการอกเสบ

(อจจาระ ปสสาวะ ชนเนอ เลอด)

(ปอด ตบ ล าไส กระเพาะปสสาวะ)

Page 64: Blood flukes Intestinal flukes - med.cmu.ac.th€¦ · INTESTINAL FLUKES Approximately 40 species were reported in Thailand 50 million people are infected Most of intestinal flukes

Intestinal flukes

Fasiolopsis buski

Haplorchis taichui

Blood flukes

metacercaria

Forked-tail cercariaSchistosoma spp.

Infective stageFlukes

1. Large

2. Small

Page 65: Blood flukes Intestinal flukes - med.cmu.ac.th€¦ · INTESTINAL FLUKES Approximately 40 species were reported in Thailand 50 million people are infected Most of intestinal flukes

พยาธใบไมปอด พยาธใบไมล าไสใหญ เลก

พยาธใบไมเลอดพยาธใบไมตบ

Page 66: Blood flukes Intestinal flukes - med.cmu.ac.th€¦ · INTESTINAL FLUKES Approximately 40 species were reported in Thailand 50 million people are infected Most of intestinal flukes

พยาธใบไมพยาธใบไมล าไส พยาธใบไมเลอดพยาธใบไมปอด พยาธใบไมตบ

Page 67: Blood flukes Intestinal flukes - med.cmu.ac.th€¦ · INTESTINAL FLUKES Approximately 40 species were reported in Thailand 50 million people are infected Most of intestinal flukes
Page 68: Blood flukes Intestinal flukes - med.cmu.ac.th€¦ · INTESTINAL FLUKES Approximately 40 species were reported in Thailand 50 million people are infected Most of intestinal flukes

Adult Egg

Haplorchis taichui

EggAdult

Fasciolopsis buski

Page 69: Blood flukes Intestinal flukes - med.cmu.ac.th€¦ · INTESTINAL FLUKES Approximately 40 species were reported in Thailand 50 million people are infected Most of intestinal flukes

Adult Egg

Page 70: Blood flukes Intestinal flukes - med.cmu.ac.th€¦ · INTESTINAL FLUKES Approximately 40 species were reported in Thailand 50 million people are infected Most of intestinal flukes