?????? Schistosomiasis japonica

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??????Schistosomiasis japonica
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Brief Introduction

• ????(Schistosomiasis)?????????????(?????????),????
  ????????????
• ??????????????????????,??????????
• ?????????,???????????????2000????? ?
• ?????????????????12????????,???????????
  ,WHO???????????

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Epidemiology

• ??? Sources of infection
• ??????????????
• ???? Route of transmission
• ??????? ????????????????????????????????
• ???? susceptible population
• ????????,????????,????
• ???? Epidemic features
• ????????,?????????????3???,??????????,????????,?
  ?????

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Distribution of schistosomiasis cases in 2003
Province Population in endemic county (x10000) Population in endemic township (x10000) Population in endemic village (x10000) No. current cases No. cases No. cases No. cases
Province Population in endemic county (x10000) Population in endemic township (x10000) Population in endemic village (x10000) No. current cases Acute cases Chronic cases Advanced cases
Shanghai 639.14 405.57 305.61 0 2 0 0
Jiangsu 3897.71 2386.90 1242.16 25438 116 22541 2781
Zhejiang 2975.39 1716.77 957.00 1187 2 0 1187
Anhui 2103.64 1177.51 601.56 60647 256 54751 5640
Fujiang 1077.43 319.31 83.28 0 0 0 0
Jiangxi 1706.49 830.41 442.67 131253 126 127468 3659
Hubei 3652.52 2144.67 952.75 295383 247 290879 4257
Hunan 1741.51 902.48 612.59 205461 234 199819 5408
Guangdong 773.55 184.70 73.29 0 0 0 0
Guangxi 1215.52 278.14 80.46 0 0 0 0
Sichuan 3132.95 1655.41 1023.29 76888 58 75321 1509
Yunan 491.14 239.61 162.86 46750 73 46677 0
Total 23406.99 12241.48 6537.52 843007 1114 817456 24441
imported cases from other provinces imported cases from other provinces
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Correlation

• ???????????????????? 2001?12?13? ????
• ?????????????????????????? 2001?12?12?
  ????-????
• ???????? ????????????? 2002?02?26? ?????
• ???????? ????????2
• 2003????????????2002???165??????1??????????,?????
  ?????,???????????2004?10?13??????

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Characteristics of schistosoma

• ?????,???????,????
• ??????(????)??,?????????
• ????????????
• ??????,?????
• ??????????
• ????,?????????,?????

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Morphology ???

• ?????,?????
• ?????????????????????????,???????????????

Adult schistosome worms measure 1 to 2cm in
length.
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??? ( The Life Cycle)

• ?????????????????????????(??)
  ????????????????????????(????????)
  ?????????????? ??? ?? ?????? ??? ???
  ???????????? ?????????? ?????????????

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Schistosoma parasitized in intestinal veins
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Pathogenesis 1

• ? ? Cercaria During the invasive stage,
  cercaria-associated dermatitis reflects dermal
  and subdermal inflammatory responsesboth humoral
  and cell-mediated.
• ?????  Cercarial dermatitis
• ???????????????????,??????????????????
•  

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Pathogenesis 2

• ?? schistosomulum
• ????? Haemorrhagic pneumonia
• ????,????,?????,?????????,??????????????????????
  ,????????????????????????????????????????????????

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Pathogenesis 3

• ?? ?????????????????????,???????????????????????,?
  ???????????,???????,??????
• Adult schistosoma, not play a significant role
  in pathogenic events.

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Pathogenesis 4

• ?? ????????????,??????????????????????????????,??
  ?????????
• Ova carried by portal blood embolize to the liver
• and intestine , granulomas are formed.
• Granulomas contribute to the liver enlargement
• and liver Fibrosis.
• Immunomodulation is an essential mechanism in
  shaping the clinical and pathologic outcome of
  schistosomiasis.

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Pathology

• ??????????
• ?? ???-???????????
• ???- ?????-???-??
• ?? ??-????????????
• ????
• ??- ???????????
• ???????????

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???????Eggs in the liver
??????? miliary tubercle
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Ova granuloma

• ???????(1) ???????
• ???????????????(soluble egg antigen,SEA)??????????
  T ???T??????????????T????????????????????????????
  ??????????,?????,???????
• ????????????????

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Ova granuloma

• ???????(2)
• ???,???????????,?????????????????
• ????????????,????,?????????????????????????,??????
  ?(pipestem fibrosis),????????????????????????,????
  ???,???????,????,????????????,???????????????

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Ova granuloma

• The granulomatous response around these ova is
  cell-mediated and is regulated both positively
  and negatively by a cascade of cytokine,
  cellular, and humoral responses.
• Granuloma formation begins with recruitment of a
  host of inflammatory cells in response to
  antigens secreted by the living organism within
  the ova.

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Immunity ???

• ???????????
• ????(Concomitant Immunity)
• ?????????,??????,????
• ????????????,???????,??????
• ????,???????????????????--??

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Clinic Manifestation

• ????????????
• Acute stage ???????12???,?????????????????????,?
  ??,??????????,??1-3??
• Chronic stage 90???????????????????????????????
  ????????????????????????
• Complication ????????????

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Clinic Manifestation

• Late stage ??????5???,???????????????????
• ???,megalosplenia type
• ???, ????
• ??? ascitic type ???????
• ???????????????????????????,?????
• ??? dwarf type ?????????????,???????????????

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The late-stage patient

• The abdomen of an 11-year-old boy with intestinal
  schistosomiasis with the size and extent of the
  liver and spleen marked. Both are well below the
  midline, indicating the severity of infection.
  The disease has caused a stunting of the boy's
  growth, he is only 120cms tall and weighs 22 kg.

????????
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Heterotropic parasitism

• ?????????????????????????
• ???????????????????????????????????
• ??????????????
• ????????????????,??????????????????????????????,?
  ????????

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Laboratory Findings

• ?????????????????
• 1.?????  parasite examination
• ???????????,
• ???????????
• 2.??????  ?????????????
• ??,??????????
• 3.???? immunological examination
• ???????????

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Laboratory Findings

• ?? ???????????,????
• ????
• ???? ?? ????????ALT???
• ?,?? ????,?? ?????
• ?????
• B? ????????,????????
• ???
• CT ???????????????????

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Diagnosis, Differential Diagnosis

• ??????(????????????????????????????)
• ?????????????????
• ?????????????????????????
• ??????(?????????????????????)?????(??????????)
  ?????(??????)

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Diagnosis

• History of epidemiology
• Travel history in endemic areas
• Infective water contact
• Clinic presentation
• Acute, chronic and late stage
• Laboratory findings
• Eggs in the feces and other tissues
• Immunologic techniques used

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Treatment and Prevention

• ??? ??? ??????,
• ?? ?????120 mg/kg(??140, mg/kg) 4?6??? ??
  ?????60 mg/kg(???60kg??), ??2?????(??lt
  30kg)??70 mg/kg?? ?????????????
• ?? ??????,????,???????,??,????????????????
• ?? ??????????????,?????????????????????

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Drug Therapy for blood flukes Infections
Treatment of schistosomiasis depends on the
stage of infection and the clinical
presentation.
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Basic strategies for schistosomiasis control in
China
Morbidity control
Infection control
Transmission control
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Case Study

• ????,????,???????????????2???1?????????????2
  3?,?????4-6?,??????,??????,???,????????????????,?
  ?(-),???1cm,????3cm?????????11?109
  /L,?????0.56,????0.16,??????0.28?????????????????