蠕虫病

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蠕虫病
Ascaris infection in the x-ray image- ascaris arranged tidily along the long axis of the small bowel (South Africa) (16424840021).jpg
X射线图像,以钡作为造影剂,显示南非某感染者小肠中的蛔虫(一种蠕虫)
醫學專科 感染科

蠕虫病,也称为蠕虫感染,是人和其他动物一部分身体被寄生蠕虫感染导致的一种巨噬细胞疾病。这些寄生虫种类很多,大致分为絛蟲吸蟲线虫。它们通常生活在宿主的胃肠道中,但也可能钻入其他器官,引起生理损伤。

土源性蠕虫病英语Soil-transmitted helminthiasis血吸虫病是最重要的蠕虫病,属于被忽视热带病[1]。2012年,世界领先的制药工程非政府组织共同启动了一项名为“被忽视热带病伦敦宣言”的项目,旨在到2020年控制或根除某些被忽视的热带病[2]

目前已发现蠕虫病会导致婴孩产出不良、认知发育不良、学业和工作表现不佳、社会经济发展不良以及贫困[3][4]。其它次要影响包括慢性病、營養不良贫血[5]

土源性蠕虫病英语Soil-transmitted helminthiasis是造成全世界四分之一的寄生虫感染的原因[6]。此类病的一个典型例子是蛔虫病

迹象和症状[编辑]

蠕虫病的症状取决于许多因素,包括感染部位、蠕虫类型、蠕虫数量、蠕虫体积、伤害类型、免疫反应等。如果身体供给物质和能量给寄生虫的负担很轻,则可能没有任何症状。某些蠕虫可能会导致特定的症状,例如绦虫可导致癫痫发作[7]

临床照片示例:几内亚蠕虫感染(麦地那龙线虫病),蠕虫从感染者的脚下钻出
蛔虫感染:由于大量蛔虫导致系膜小肠对向部分裂(南非)

质量和体积[编辑]

在肠道感染的极端情况下,蠕虫的质量和体积如过大则可能导致肠壁外层(例如肌肉层)撕裂,进而可能导致肠道腹膜炎、肠扭转和坏疽[8]

免疫反应[编辑]

蠕虫作为病原体可诱导产生免疫反应,皮肤、肺、肝、肠、中枢神经系统和眼睛可发生免疫介导炎症变化。身体免疫反应迹象可能包括水肿关节炎和嗜酸性粒细胞增多[9]。例如蛔虫幼虫通过肺部支气管迁移可引起哮喘[10]

流行病学[编辑]

死亡[编辑]

每年有多达135,000人死于土源性蠕虫病[3][11][12]

1990至2013年全球疾病负担研究英语Global Burden of Disease Study估计血吸虫病直接致死人数为5,500人[13],而2013年估计有超过20万人死因与血吸虫病有关[14]。此病另外还对2000万人造成严重后果[15],是被忽视热带病中最致命的一种[16]

蠕虫属 俗名 每年感染者数(百万) 每年直接致死者数 多发区域
土源性蠕虫病(属于被忽视热带病):
Ascaris lumbricoides 线虫 807至1,121[17] 20,000 东南亚、非洲、中美洲和南美洲多地[18][19][20][21][22][23]
Trichuris trichiura 鞭蟲 604至795[17] 亚洲、非洲、中美洲、南美洲和加勒比岛屿的潮湿、温暖、热带地区[20][21][22][23][24]
Ancylostoma duodenale 钩虫 576至740(一般意义上的钩虫)[25] 热带和亚热带国家(撒哈拉以南的非洲地区)[21][24]
Necator americanus
Strongyloides stercoralis 钩虫蟯蟲 50至100 数千人 热带和亚热带潮湿多雨地区,以及南欧、东欧和美洲部分地区[21][22]
所有土源性蠕虫病 1500至2000[6] 135,000[3][11][12] 热带和亚热带地区,尤见于撒哈拉以南的非洲、美洲、中国和东亚[6]
不通过土壤传播,但属于被忽视热带病:
Schistosoma mansoni 血吸虫 所有血吸虫总计:160至200

(210人“受影响”[26]

12,000[27](150,000人死于肾功能衰竭[28]

200,000人死因与血吸虫病有关[14]

热带和亚热带地区[20][21][22][23][24]
Schistosoma haematobium 112(仅撒哈拉以南的非洲)[28]
Echinococcus granulosus 3[29] 发展中国家
不通过土壤传播,也不属于被忽视热带病:
Toxocara canis 线虫 50 东南亚、非洲、中美洲和南美洲多地[18][19][20][21][22][23]
Taenia solium 猪肉绦虫 50 南美洲、东南亚、西非和东非[20][21][22][23]
Taenia saginata 牛肉绦虫 50
Hymenolepis nana 侏儒绦虫 100
Hymenolepis diminuta 鼠绦虫
Fasciola hepatica
Fascioloides magna
肝吸虫 50 主要分布与南亚和东亚,但也见于中欧和东欧[21][22]
Fasciolopsis buski 巨型肠吸虫
Dracunculus medinensis 几内亚蠕虫 由于根除计划,如今可以忽略不计[30] 曾在印度、西非和苏丹南部广泛分布[21][22]
Trichostrongylus orientalis 线虫 1至3 亚洲农村[21][22]
其它 100 全球[21][22]
总计(感染人数) 约35亿 全球

参考资料[编辑]

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