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1、Chapter 19 Human Parasitosis 阿米巴病阿米巴病血吸虫病血吸虫病Amoebiasis 阿米巴病ooAmoebiasis is a human parasitosis mostly caused by entamoeba histolytica 溶组织内阿米巴ooIntestinal amoebiasis ooAmoebic liver abscess ooAmoebic pulmonary abscess ooAmoebic cerebral abscess Intestinal amoebiasis 肠阿米巴ooPathogenesis 包囊体-滋养体omechan
2、ical injury and phagocytosisooContact lysis 接触溶解 ooCyto-toxic 细胞毒素ooBacterial 协同oSusceptibility 易感性-男性oImmune suppression and Immune escape 免疫抑制逃避-长期存在MorphologyooLocation: firstly involves cecum盲肠, colon ascendens 升结肠, secondly sigmoid colon and rectum, in some cases involve the whole colon and inf
3、erior segment of small intestineooflask shaped ulcer 烧瓶状溃疡ooAcute phaseooChronic phaseAcute PhaseooGrossGrossoYellowish spotty necrosis/ulceroSwelling, edema and bleeding zoneoMap necrosis, filled with yellowish-brown mucous purulence substanceooHistologyHistologynliquefaction necrosis 液化性坏死, only m
4、inor , only minor inflammation nearbyinflammation nearbyn nLarge amoebic Large amoebic trophozoite can be seen in the juncture of necrosis and normal tissuen n vacant space around trophozoiteChronic PhaseooMixture of fresh and old lesionooNecrosis, ulcer with proliferationoepithelial proliferation a
5、nd polypoFibrous proliferation, scar, thicken and harden of the enteric wall, stricture of enteric cavityo阿米巴肿 ameoboma p486Amoebic liver abscess oAmoeba trophozoite penetrate the vein of enteric wallvena mesentericaVena portalis hepatisliverliverooGrossGrossn nSingle, the size of abscess variedSing
6、le, the size of abscess variedn nThe The fruit jam substance consists of liquification, liquification, oboslete bleeding 果酱样大便n nAbscess wall consists of the connect tissue of vena Abscess wall consists of the connect tissue of vena portalis hepatis, like old cotton portalis hepatis, like old cotton
7、 破絮状破絮状n nMinor inflammation around the abscess Minor inflammation around the abscess ooHistologyHistologyn nPus cells, necrosisPus cells, necrosisnAmoeba trophozoite around the wall of abscessAmoebic pulmonary abscess ooRare, developed from Amoebic liver Rare, developed from Amoebic liver abscess,
8、which penetrate the abscess, which penetrate the disphragmatic muscleooMost commonly single, often located Most commonly single, often located lower lobe of the right lung, may connect with liver abscessooThe liquification necrosis may be The liquification necrosis may be discarded, and the discarde
9、d, and the pulmonary cavity formedooDark brown Dark brown purulent expectoration, 脓性痰Amoeba trophozoite may be found Schistosomiasis 血吸虫病 p487oSchistosomiasis infects approximately 200 million persons and kills approximately 280,000 annually. oMost of the mortality comes from hepatic granulomas and
10、fibrosis.oIn addition, Schistosoma haematobium, found in Africa, causes hematuria and granulomatous disease of the bladder, resulting in chronic obstructive uropathy.Achistosomiasis 血吸虫病ooEtiology and route of infection n ncercarial dermatitis cercarial dermatitis 尾幼性皮炎、稻田皮炎、游泳痒尾幼性皮炎、稻田皮炎、游泳痒n n童虫引起
11、肺损伤童虫引起肺损伤 n nDamage by Damage by 成虫：静脉内膜炎及其周围炎、血栓形成、成虫：静脉内膜炎及其周围炎、血栓形成、贫血、嗜酸性粒细胞增多、肝脾肿大贫血、嗜酸性粒细胞增多、肝脾肿大 n nDamage by egg Damage by egg n nDamage by the antigens and immune Damage by the antigens and immune compounds in circulation compounds in circulation 肾脏损害肾脏损害Pathogenesis and morphologyPathogen
12、esis and morphologyMorphology of organs - ColonooAcute phase Acute phase 血吸虫病痢疾血吸虫病痢疾n nCongestion, edema, gray-yellowish or yellow-Congestion, edema, gray-yellowish or yellow-whitish nodule, 0.5whitish nodule, 0.54mm in diameter4mm in diametern nThe nodule may break The nodule may break ulcerulcern
13、 nThe eggs in the ulcer may be discarded and The eggs in the ulcer may be discarded and become pollution become pollution 污染源污染源ooChronic phaseChronic phasen nEggs, fibrous proliferation, scaring Eggs, fibrous proliferation, scaring n nUlcer, necrosis, narrowing or obstruction of the Ulcer, necrosis
14、, narrowing or obstruction of the enteric cavity enteric cavity 肠腔狭窄肠腔狭窄Morphology of organs- LiverooAcute phase Acute phase 急性虫卵结节急性虫卵结节- -嗜酸性脓肿嗜酸性脓肿n nSwelling of liver, not smooth in the surface, Swelling of liver, not smooth in the surface, numerous numerous millet or mung bean sized yellow or w
15、hitish nodules in the surface or the cutting surfacen nHistologically, the acute egg Histologically, the acute egg tubercle mainly located around portal area, the atrophy, degeneration and focal necrosis of hepatocytes can be seencan be seenooChronic phase Chronic phase 慢性虫卵结节慢性虫卵结节- -假结核结节假结核结节n nE
16、ggs, fibrous proliferation, calcificationEggs, fibrous proliferation, calcificationn nFibrous proliferation around the portal area, thicken of Fibrous proliferation around the portal area, thicken of the wall of veins, thrombosisthe wall of veins, thrombosisn nStem live Stem live liver cirrhosisnPor
17、tal hypertension and relative symptomsoMorphology. In mild S. mansoni or S. japonicum infections, white, pinhead-sized granulomas are scattered throughout the gut and liver. oAt the center of the granuloma is the schistosome egg, which contains a miracidium; this degenerates over time and calcifies.
18、 oThe granulomas are composed of macrophages, lymphocytes, neutrophils, and eosinophils; the last-mentioned are distinctive for helminth infections. oThe liver is darkened by regurgitated heme-derived pigments from the schistosome gut, which, like malaria pigments, are iron-negative and accumulate i
19、n Kupffer cells and splenic macrophages.Schistosoma mansoni granuloma with a miracidium-containing egg (center) and numerous, adjacent, scattered eosinophils.oIn severe S. mansoni or S. japonicum infections, inflammatory patches or pseudopolyps may form in the colon. oThe surface of the liver is bum
20、py, whereas cut surfaces reveal granulomas and a widespread fibrous portal enlargement without distortion of the intervening parenchyma by regenerative nodules. Because these fibrous triads resemble the stem of a clay pipe, the lesion is named pipe-stem fibrosis. oMany of these portal triads lack a
21、vein lumen, causing presinusoidal portal hypertension and severe congestive splenomegaly, esophageal varices, and ascites. 门脉高压重，肝功能损害轻oSchistosome eggs, diverted to the lung through portal collaterals, may produce granulomatous pulmonary arteritis with intimal hyperplasia, progressive arterial obst
22、ruction, and ultimately heart failure (cor pulmonale). 肺心病oOn histologic examination, arteries in the lungs show disruption of the elastica layer by granulomas and scars, luminal organizing thrombi, and angiomatoid lesions similar to those of idiopathic pulmonary hypertension. oPatients with hepatos
23、plenic schistosomiasis also have an increased frequency of mesangioproliferative or membranous glomerulopathy, in which glomeruli contain deposits of immunoglobulin and complement but rarely schistosome antigen.Pipe-stem fibrosis of the liver due to chronic Schistosoma japonicum infection 干线型肝硬变Morp
24、hology of organsooEctopicn nLungLungn nBrain Brain 急性脑炎、癫痫急性脑炎、癫痫n nOthers Others 肾、胰腺、胆囊、心脏、膀胱、子宫肾、胰腺、胆囊、心脏、膀胱、子宫ooSchistosoma dwarfism 血吸虫侏儒症ooAcute schistosomiasis 急性血吸虫病Amoebiasis 小结oEntamoeba histolyticaoIntestinal AmoebiasisoAmoebic dysenteryoContact lysisoEnterotoxinoAcute changeFlask shaped
25、ulceroChronic changeAmoebomaExtraintestinal amoebiasisoAmoebic liver abscessoAmoebic plumonary abscessoAmoebic cerebral abscess血吸虫病小结oCercarial dermatitisoEosinophilic abscessoPseudotubercleoPipe stem cirrhosisoEctopic parasitismoSchistosoma dwarfismoAcute schistosomiasisPathogens:病原病原vPyogenicmenin
26、gitis:化脓性脑膜炎化脓性脑膜炎Meningococci,Hinfluenza,Pneumococci,Streptococci,Staphylococci,EColivGranulomatousmeningitis:肉芽肿性脑膜炎肉芽肿性脑膜炎T.B.mycobacterium,FungivLymphocyticmeningitis:淋巴细胞性脑膜炎淋巴细胞性脑膜炎viruses,spirochetesMeningitis脑膜炎脑膜炎401MENINGITIS oMeningitis refers to an inflammatory process of the leptomening
27、es and CSF within the subarachnoid space. oMeningoencephalitis refers to inflammation of the meninges and brain parenchyma. 脑膜脑炎oMeningitis is usually caused by an infection, but chemical meningitis may also occur in response to a nonbacterial irritant introduced into the subarachnoid space. 化学性oInf
28、iltration of the subarachnoid space by carcinoma is referred to as meningeal carcinomatosis (sometimes called carcinomatous meningitis) and by lymphoma as meningeal lymphomatosis. 瘤性oInfectious meningitis is broadly classified into acute pyogenic (usually bacterial meningitis), aseptic (usually acut
29、e viral meningitis), and chronic (usually tuberculous, spirochetal, or cryptococcal) on the basis of the characteristics of inflammatory exudate on CSF examination and the clinical evolution of the illness. EpidemicMeningococcicMeningitis(流行性脑膜炎双球菌性脑膜炎流行性脑膜炎双球菌性脑膜炎)oPathogen:meningococci,epidemicsea
30、sons:Winter&SpringoBacteriaspreadbyair(sneezeandspray),locatedatnasopharyx,mostarebacteriacarrier(15%population,inepidemicseason:7080%)oVictimsarechildren,mostyoungerthan10yrsoldoBasicchanges：acutepurulent化化脓脓性性inflammation(Leptomeninge&CSF)oClinical symptoms & signs: fever,headache, vomiting, petec
31、hia &ecchymosis on the skin & mucosa, meningeal irrigative signs, shock inseverecasesoTemporaryimmunityafterrecoveryMeningitisPathogen:meningococci,endotoxinandcapsulearepathogenicRouteofinfection:SprayfromcarrierMucosaofnasopharyxBlood(septicemiaorbacteremia)leptomenigesmeningitisUsually5%30%,7080%
32、inepidemicperiodURI,catarrh(sorethroatredandedematousmucosa,mucousdischarge)PetechiaecchymosisBacterialemboliVascularparalysis,dilation,thrombosisshockbilateralseverehemorrhageofadrenalcortex(Waterhouse-Friderichsensyndrome)(+)Meningitis-PathologicalChangesVassels:bacterialthrombi,thrombosis,focalhe
33、morrhageMeninge:acutepurulentinflammationGross:vdura:tense,hyperemicvSubarachnoidspacefilledwithgrayishyellowpusespeciallyatconvexofhemisphere，atthebaseincisternae,andalongcircleWillis,rootsofcranial&spinalNervesLM：vStrikinglyenlargedsubarachnoidspacewithlargeamountofpurulentexudation,mainlypolys.vV
34、ascularcongestionvAdjacentbrainparenchymabeedematousMeningitisClinicalPathologicalCorrelation(CPC)MeningealirritationsignsinflammationSwellingofrootsofcranial&spinalNCompressionatostioleorintervertebralholesPreventivemuscularspasmatbackinordertofixthepositionofnerverootatholesKernigsSign(+)Brudzinsk
35、iSign(+)neckstiffnessoropisthotonusMeningitisCPCHypertentionofICPInflammatoryexudeadhesionofarachnoidgranulesdecreasingabsorptionofCSFvascularcongestioncerebraledemaProjectilevomitingheadachecomaCSFchangesMeningitisCPCCSFChangesIncreasingpressureTurbid,protein，cellcountPus(+),bacteria(+)SugarMeningi
36、tisCPCWaterhouse-Friderichsen syndrome(华华佛佛氏氏综综合合征征) ) severesepticemialargeamountofendotoxinreleasedDICshockbilateralhemorrhageofadrenalcortexExtensiveecchymosispurpuraMildornomeningealchangesPrognosis:quitegood.Theusageofantibioticsmakesmorethan90%patientsrecovered.Complications:quitefew1.hydrocep
37、halus:脑脑积积水水duetoinflammatoryadhesion,decreasingabsorptionofCSF2.cranial nerve injury: palsy, blindness, deafnessstrabismus(III、IV、V、VII)3.Cerebral infarction脑脑梗梗死死: inflammation vessels inflammatoryinjuryandoccluded4.focaladhesivearachnoiditisMeningitis-ConsequenceandprognosisRemarksonviralinfectio
38、nAbsoluteparasitisminhostcells,selectivevulnerabilityofdifferentgroupofneuron.绝对细胞内寄生绝对细胞内寄生403Invadesneuron:cytolysis,inclusionbodyformation狂犬病狂犬病Negri小体小体Gliacellproliferation,multinucleargiantcell(HIV)T/BcellimmunityEpidemicJapaneseBEncephalitis(流行性乙型脑炎流行性乙型脑炎)1.ThediseaseiscausedbyJapaneseBEncep
39、halitis(RNA)virus,mostcasesshowacuteclinicalcourse,epidemicinsummerandautumn.2.Victims are children, teenagers, with drowsiness, higherfever,severeheadache,convulsion,vomiting,deepcoma.3.Basicpathologicalchangeisalterationdominantinflammation变质性炎症变质性炎症4.PermanentimmunityaftersufferingofdiseaseEnceph
40、alitisBJap.oPathogen：Encephalitis B Jap. Virus (RNA)oRoute of InfectionbiteofmosquitovirusEndotheliumoflocalbloodvesselsMfurthermultiplicationviremianormalimmunity&BBBincompetentBBBsubclinicalinfectionneuronencephalitisEncephalitisBJap.PathologyoGraymatterinvolved.mainlyCerebralCortexB.G.ThalamusoGr
41、ossInspection:CongestionofMeningesBrainEdemaoMicroscopicfindings:1.Sieve-likesofteningfoci,welldemarcated软化灶软化灶Necrosisofneuronswithfoamycellformation2.Congestionandperivascularcuffing血管周围套血管周围套3.Proliferationofglialcells胶质细胞增生胶质细胞增生Microgliaproliferation(acutestage)Astrocyteproliferation(chronicsta
42、ge)EncephalitisBJapClinicopathologicalCorrelation(CPC)inflammationcongestiondamageofendotheliumhypertensionofICPcerebraledemaHeadachevomitingtonsilarherniationDrosinessconvulsioncoma(+)pneumoniaandothercomplicationssuddendeathdegenerationandnecrosisofneuronEncephalitisBJapConsequencesandComplication
43、soHighmortalityascompareswithepidemicmeningitisoComplications:mentalretardation,dementia,aphasia,paralysisofcranialorperipheralN.Pyogenic meningitis. A thick layer of suppurative exudate covers the brain stem and cerebellum and thickens the leptomeninges.o Characteristic findings of viral meningitis include perivascular cuffs of lymphocytes (A) and microglial nodules (B).
