醫(yī)學(xué)寄生蟲(chóng)學(xué)：實(shí)習(xí)一 線蟲(chóng)（一）

1、人體寄生蟲(chóng)學(xué)實(shí)習(xí)課線蟲(chóng)（一） 實(shí)習(xí)一、線蟲(chóng) I鉤蟲(chóng)（Hookworm）： 十二指腸鉤口線蟲(chóng) Ancylostoma duodenale 美洲板口線蟲(chóng) Necator americanus蛔蟲(chóng)： Ascaris lumbricoides 鞭蟲(chóng)： Trichuris trichiura蟯蟲(chóng)： Enterobius vermicularis目的和要求1.掌握：鉤蟲(chóng)卵、蛔蟲(chóng)(受精、未受精)卵、鞭蟲(chóng)卵和蟯蟲(chóng)卵形態(tài)特征；鉤蟲(chóng)成蟲(chóng)形態(tài)特征及兩種鉤蟲(chóng)的形態(tài)區(qū)別;蟯蟲(chóng)成蟲(chóng)形態(tài)特征。2.熟悉：兩種鉤蟲(chóng)口囊和交合傘形態(tài)及其區(qū)別;蟯蟲(chóng)成蟲(chóng)頭部食道球、頭翼形態(tài)。3.了解：蛔蟲(chóng)成蟲(chóng)（）、鞭蟲(chóng)成蟲(chóng)（ ） ?；紫x(chóng)： Asca

2、ris lumbricoides life cycleAdult worm蛔蟲(chóng)成蟲(chóng)：形似蚯蚓，柱狀體，兩端略尖，表面光滑，尾部挺直而鈍園，雌蟲(chóng)長(zhǎng)，20-40cm，雄蟲(chóng)小，15-30cm，新鮮蟲(chóng)體淡紅色 ，固定后乳白色。Adult lips Three lips around the mouth in “品”type and possess small teethCopulatory spines of male蛔蟲(chóng)橫切片：（示教）Eggs受精卵未受精卵大小中等大小,蟲(chóng)卵參照標(biāo)準(zhǔn)形狀短、寬橢圓形窄橢圓形顏色棕黃色（膽汁染色）卵殼厚度厚而透明，外附波浪形蛋白質(zhì)膜卵內(nèi)容物一個(gè)大而圓的卵細(xì)胞，與卵殼形

3、成新月形間隙充滿卵黃顆粒受精卵未受精卵新月形間隙Three fertilized eggs (one decorticated, on the right) of Ascaris lumbricoides.脫殼蛔蟲(chóng)卵(decorticate egg) 卵殼則呈無(wú)色透明，應(yīng)與其他線蟲(chóng)卵的鑒別Fertilized Ascaris EggTwo fertilized eggs from the same patient, where embryos have begun to develop (this happens when the stool sample is not processed f

4、or several days without refrigeration).Embryonated Eggs of Ascaris (infective egg)Egg containing a larva, which will be infective if ingested.形狀與受精卵基本相同，卵內(nèi)含有活的線狀幼蟲(chóng) 兩種蛔蟲(chóng)卵比較受精蛔蟲(chóng)卵未受精蛔蟲(chóng)卵大小6045m9040m形狀寬橢圓形長(zhǎng)橢圓形顏色棕黃色棕黃色卵殼厚、外披蛋白膜，凹凸不平殼及蛋白膜均薄內(nèi)容含一個(gè)圓形卵細(xì)胞，殼間有新月形空隙含大小不一的折光性卵黃顆粒鞭蟲(chóng)： Trichuris trichiuralife cycleAd

5、ult worm鞭蟲(chóng)成蟲(chóng)：蟲(chóng)體形似馬鞭，灰白色，前3/5處細(xì)長(zhǎng)，后2/5處較粗，雄蟲(chóng)長(zhǎng)3040mm，尾端向腹面彎曲。雌蟲(chóng)較大，長(zhǎng)3550mm，尾端無(wú)彎曲。 Trichuris Adult MaleTrichuris adult male showing the spicule protruded. Interference contrast. 50. Eggs大小中等大小，比受精蛔蟲(chóng)卵小形狀紡錘形（似腰鼓）顏色淺黃褐色 卵殼厚度較厚，兩端各有一個(gè)突起的蓋塞卵內(nèi)容物一個(gè)未發(fā)育的受精卵蓋塞鉤蟲(chóng)：Hookworm lifecycle兩種鉤蟲(chóng)成蟲(chóng)的鑒別十二指腸鉤蟲(chóng)美洲鉤蟲(chóng)體形“C” “S” 口囊扁卵圓

6、形橢圓形 齒鉤齒2對(duì)板齒1對(duì)交合傘 圓形扁圓形背輻肋遠(yuǎn)端2支、末端再分3小支基部分2支、每支各分2小支Adult wormC S十二指腸鉤口線蟲(chóng) Ancylostoma duodenale美洲板口線蟲(chóng) Necator americanusAdult worm（口囊）十二指腸鉤口線蟲(chóng) Ancylostoma duodenale美洲板口線蟲(chóng) Necator americanusbuccal capsuleFlat and oval-shape; two pairs cutting teethOval-shape; one pair cutting platesA. duodenale and N.

7、americanus -copulatory bursa and spicules of maleDorsal ray: Divided into 2 branches at the distal end, each subdivided into 3 small ranches Divided into 2 branches at the base each subdivided into 2 small branchesroundoblate腹輻肋側(cè)輻肋背輻肋 Dorsal rayA. duodenale and N.americanus - copulatory bursa and sp

8、icules of maleThe needlelike spicules have simple tips and are never fused distally.The spicules are fused at their distal ends and form a characteristic hook.Adult worm（交合傘）十二指腸鉤口線蟲(chóng) Ancylostoma duodenale美洲板口線蟲(chóng)Necator americanus腹輻肋側(cè)輻肋背輻肋大小中等大小，與受精蛔蟲(chóng)卵相仿形狀長(zhǎng)橢圓形顏色無(wú)色透明 卵殼厚度極薄，如同細(xì)線卵內(nèi)容物28個(gè)顏色較深的卵細(xì)胞 細(xì)胞與卵殼之間有

9、明顯空隙Hookworm eggs四細(xì)胞期卵多細(xì)胞期卵成熟含蚴卵Differences between Decorticated Ascaris and Hookworm eggsDecorticated ascaris egghookworm eggShellthickthinEgg cellunsegmented4-8cellsSpace between Shell and cell new moon shaped spaceempty space surroundingthe segmented cells蟯蟲(chóng)： Enterobius vermicularislife cycleAdul

10、t worm蟯蟲(chóng)成蟲(chóng)：蟲(chóng)體細(xì)小，白色，形如白色線頭狀，蟲(chóng)體后端尖細(xì)，雄蟲(chóng)長(zhǎng)3-5mm，尾端向腹面彎曲。雌蟲(chóng)較大，長(zhǎng)1cm。 Enterobius vermicularis adult worm special structures食道球部頭翼cephalic alaeesophageal bulbEggs大小比受精蛔蟲(chóng)卵小形狀長(zhǎng)圓形，兩側(cè)不對(duì)稱，一側(cè)突出，一側(cè)較平顏色無(wú)色透明 卵殼厚度較厚卵內(nèi)容物一個(gè)蝌蚪期幼蟲(chóng)Anal smear showing large numbers of Enterobius eggsIn the background are also two Ascaris egg

11、s.100. 觀察及繪圖: 畫出鉤蟲(chóng)卵、受精與未受精蛔蟲(chóng)卵、蟯蟲(chóng)卵和鞭蟲(chóng)卵圖，要求：注意形態(tài)特征，標(biāo)注主要結(jié)構(gòu)名稱用箭頭和文字描述鉤蟲(chóng)生活史過(guò)程觀察示教標(biāo)本及瓶裝標(biāo)本生物繪圖：卵殼卵細(xì)胞透明間隙Thanks病 例 一 患者男性，18歲，山東新汶人。1999年10月18日入院。主訴：突發(fā)右上腹部疼痛半天?，F(xiàn)病史：當(dāng)天午飯后突然發(fā)生右上腹部疼痛，始為鈍痛，繼而轉(zhuǎn)為陣發(fā)性劇痛，疼痛不向其他部位放射。劇疼時(shí)患者輾轉(zhuǎn)不安，在炕上翻滾，滿頭大汗。曾嘔吐2次，第2次吐出1條蛔蟲(chóng)。曾在鄉(xiāng)衛(wèi)生院肌注止痛針1支，隨后疼痛減輕。當(dāng)晚因再次出現(xiàn)陣發(fā)性劇痛、發(fā)燒而來(lái)院就診。既往史：平時(shí)經(jīng)常臍部周圍疼痛，去年曾服驅(qū)蟲(chóng)藥并

12、排出蛔蟲(chóng)數(shù)十條。體檢：T 38.3，發(fā)育及營(yíng)養(yǎng)狀況較差，神志清醒，表情痛苦，右側(cè)臥位。腹部平軟，右上腹壓疼明顯。心、肺、四肢等其他體征未見(jiàn)異常。化驗(yàn)：糞便常規(guī)檢查發(fā)現(xiàn)有蛔蟲(chóng)卵。血常規(guī)：WBC 10.8x109/L，N 84%， L 16%。 (該病例摘自劉永春人體寄生蟲(chóng)學(xué)應(yīng)試指南北京：光明日?qǐng)?bào)出版社，2003)問(wèn)題：1.該病例的正確診斷是什么？2.分析引起該病的原因。3.蛔蟲(chóng)感染還可能出現(xiàn)哪些癥狀？4.簡(jiǎn)述蛔蟲(chóng)感染普遍的原因。病 例 二 患者男性，43歲，農(nóng)民。近兩年來(lái)經(jīng)常有上腹部脹疼不適感，按壓或進(jìn)食后可緩解，食欲尚可，發(fā)病無(wú)一定規(guī)律。曾服用復(fù)方氫氧化鋁（胃舒平)、干酵母（食母生）等藥物未見(jiàn)

13、好轉(zhuǎn)，近1年來(lái)食欲下降，常有腹脹、腹痛，因近半年來(lái)身體消瘦、皮膚發(fā)黃、全身乏力，輕體力勞動(dòng)感到心慌氣短、頭暈、眼花，不能從事重體力勞動(dòng)；近1個(gè)月來(lái)又發(fā)現(xiàn)下肢水腫而來(lái)醫(yī)院就診。既往史：平素健康，經(jīng)常赤腳勞動(dòng)。體檢及化驗(yàn)：T 37，P 85次/分，RR 25次/分，營(yíng)養(yǎng)欠佳，慢性病面容，面色萎黃。全身皮膚干燥、萎黃；胸、肺無(wú)異常所見(jiàn)；心率稍快，心尖區(qū)可聞及收縮期2級(jí)雜音，腹部未見(jiàn)異常。雙下肢凹陷性水腫。Hb 45g/L，RBC1.29x1012/L，大便潛血（+），并發(fā)現(xiàn)有鉤蟲(chóng)卵。（該病例摘自劉永春人體寄生蟲(chóng)學(xué)應(yīng)試指南北京：光明日?qǐng)?bào)出版社，2003.3)問(wèn)題：1.該病的正確診斷是什么？2.分析該病

14、例出現(xiàn)的癥狀與體征。3.患者是如何感染的？4.今后應(yīng)如何加強(qiáng)預(yù)防？病 例 三 Case #221 -February, 2008A survey was conducted to determine the prevalence of geohelminth infections in school-age children living in Haiti. The laboratory aspect of the survey consisted of processing stool specimens which were collected in 10% formalin. Per protocol, the processing included performing an FEA (formalin-ethyl acetate) concentration and examination of a wet mount. The following images show what was found in one of the specimens. All images (Figures A-C) were taken at 200 x magnification;Figu