Enterobiasis
Introduction
Introduction to tsutsugamushi Enterobiasis is an intestinal parasitic disease that causes anal and perineal itching. It is widely spread around the world. The world's infected population is 300-500 million. It is popular in southern China and northern China. The infection rate is higher than that of adults. In particular, the infection rate of children in collective institutions is high. According to domestic survey data, the infection rate of children is 40% to 70%, and the infection rate of children in urban areas is higher than that in rural areas. In families with poor sanitation, most members are at the same time sick. basic knowledge The proportion of sickness: 0.0022% Susceptible population: children with infection rate is higher than adults Mode of infection: contact spread Complications: sciatic rectal abscess urethritis appendicitis peritonitis
Cause
The cause of tsutsugamushi disease
Cause
Contact infection (35%):
Aphid patients are the only source of infection. The infection is mainly caused by direct infection of the anus and contact infection between the population. Occasionally, the larvae that are incubated in the perianal area return to the anus and undergo retrograde infection. The disease is easily spread and is often prevalent in collective children's institutions or families.
Bad health habits (30%):
Children do not develop hand washing before meals, diligently cut nails, do not suck fingers, and frequently change underwear, bedding and other good hygiene habits. Foods and toys contaminated with eggs are infected by mouth, and they can also be infested by mouth and nose, inhaled flying eggs and then swallowed.
Pathogenesis
The pathogenic effects of aphids are multifaceted, mainly due to mechanical or chemical stimulation, nutrient consumption and complications caused by vaginal vaginal discharge and corresponding clinical symptoms.
Aphids at different developmental stages in the host gut have a certain degree of mechanical and chemical stimulation of the nerve endings of the intestinal wall, and can cause neurological and gastrointestinal dysfunction reflexively, and the head of the adult is drilled into the intestinal mucosa. The nutrition of the host can also swallow the contents of the intestines and trace blood. If the number of aphids is large, it can affect the nutrition absorption and body development of the children. The females can spawn around the anus to stimulate the skin, causing local itching, inflammation or localization. Eczema, hemorrhage and secondary infection; long-term stimulation can also cause different degrees of neurological dysfunction, aphids adhere to the intestinal mucosa, and can penetrate into the submucosa, resulting in the destruction of intestinal mucosal integrity, causing microscopic ulcers, small abscesses and Bleeding, etc., adults can also invade the appendix to cause acute or subacute appendicitis. Occasionally, females escape from the anus to lay eggs, and can enter the nearby organs to cause serious damage. They can enter the female genitourinary system; or enter the pelvic or abdominal cavity through the female reproductive system. And local spawning causes local inflammation and secondary bacterial infection; late can cause intestinal mucosal eosinophilic abscess or granuloma; It can cause organ damage, perforation, etc. In addition, there are reports of lung nodular shadows caused by aphids, which may be caused by the migration of aphids through the respiratory tract to the lungs.
The pathological changes caused by aphids are mainly submucosal lymphoid hyperplasia, neutrophil infiltration, connective tissue hyalinosis and fatty changes.
Prevention
Ascaria prevention
Aphids have a short life span and generally only survive in the intestine for 1 to 2 months. If they can eliminate repeated infections, pay attention to personal hygiene and self-healing without special treatment, but the aphids have strong resistance and develop quickly. In the infection period, the intermediate host is not needed, and the infection can be re-infected without leaving the human body. Therefore, the principle of prevention is: simultaneous treatment and prevention, and individual prevention and prevention are carried out simultaneously.
1. It is necessary to vigorously publicize the hazards of tsutsugamushi, the way of infection, the significance of prevention and treatment.
2. Make parents, teachers, and nurses fully aware of, educate children to develop good hygiene habits, wash their hands before meals, cut their nails, do not suck their fingers, etc., change their underwear, be shackled, and the childrens units must be heavily divided. There is a certain distance.
3. Clothes, toys, and food utensils should be disinfected regularly. It can be treated with 0.5% sulfonate solution for 5 minutes, or 0.05% iodine solution for 1 hour. The eggs can be completely killed. This low concentration of iodine is not irritating to human skin and is effective. And a simple disinfectant.
4. The prevention of tsutsugamushi emphasizes the application of comprehensive prevention and control measures, so as to effectively prevent reinfection and achieve the purpose of eliminating tsutsugamushi disease.
Complication
Ascariasis complications Complications, ischial rectal abs, urethritis, appendicitis, peritonitis
Common complications due to aphid prostatitis, sciatic rectal abscess, urethritis, subcutaneous nodules, ectopic lesions caused by ectopic parasites, such as: vaginitis, salpingitis, endometritis, etc. Invasion of the appendix occurs appendicitis, and even peritonitis occurs.
Symptom
Symptoms of tsutsugamushi Common symptoms abdominal pain, insomnia, heterosexual symptoms in children, night stunned bite, nausea, diarrhea, loss of appetite
About 1/3 of the mites are completely asymptomatic.
1. Itching around the anus or perineum: It is caused by toxic substances and mechanical stimuli produced by mites, especially at night, affecting sleep, children crying and uneasy, due to itching, causing skin around the anus, congestion, rash , eczema, and even induce a purulent infection.
2. Digestive tract symptoms: Aphid drilling into the intestinal mucosa, and mechanical or chemical stimulation in the gastrointestinal tract can cause loss of appetite, nausea, vomiting, abdominal pain, diarrhea and other symptoms.
3. Psychiatric symptoms: due to the metabolites excreted by the parasite in the body, leading to mental excitement, insomnia, pediatric night stunned fingers, etc., heterosexual symptoms in children, tsutsugamushi patients are the most common, such as eating clods, cinder, salt Wait.
4. Other symptoms: caused by ectopic parasitic mites, such as: vaginitis, salpingitis, endometritis, etc., can also invade appendicitis in the appendix, and even more peritonitis occurs.
Examine
Locust disease check
1. Blood routine: There are no significant changes in peripheral blood leukocytes, hemoglobin and platelets in this disease.
2. Fecal examination: The positive rate of fecal examination of aphid eggs is low, the positive rate of direct smear is only 1% to 2%, and the positive rate of concentrated microscopy is 5%.
3. Perianal examination of adults: Because aphids have the characteristics of laying eggs out of the anus at night, so observe the perianal skin folds within 1 to 3 hours after the child enters the saliva, adults or females can be found in the perineum or female genitals. This method not only has high accuracy, but also is convenient and simple, and easy to popularize.
4. Anal examination of egg scraping: rubbing or sticking to the perianal wrinkle and dirt microscopic examination, once detected the eggs are about 50%, the three detection rate is more than 90%, the anal week to check the eggs have the following Ways:
(1) Glycerin cotton swab smear method: first put the cotton swab in sterile saline solution, wipe the cotton swab and wipe the patient around the anus, then mix it on the glass slide with 50% glycerin and microscopic examination.
(2) Precipitation method: The preparation method is the same as before. The cotton swab swabbed through the perianal area is inserted into a test tube containing physiological saline, and fully shaken to wash the eggs into physiological saline. After sedimentation, the sediment is taken for microscopic examination.
(3) Cotton swab floating method: The preparation method is the same as before, the wiped cotton swab is placed in saturated physiological saline, and then the eggs are floated and examined again.
(4) Adhesive wiping method: Cut the cellophane of the glue solution into small paper strips, then stick it on the clean glass slide, remove the cellophane strip, stick the glue side to the patient's perianal area, and then put the cellophane Remove and still stick back to the original slide for inspection.
Diagnosis
Diagnosis and identification of tsutsugamushi disease
diagnosis
Such as the anus around the perineum or the perineum often itchy, children with irritability at night, should pay attention to the possibility of tsutsugamushi, if you can find the worm, eggs can be diagnosed with tsutsugamushi, diagnosis of tsutsugamushi is often transparent Adhesive paper swab method or cotton swab swab method, check the perianal before the morning morning or before bathing. This method is easy to operate and the detection rate is high. If it is detected, the eggs can be diagnosed.
Differential diagnosis
Most of the disease has only mild abdominal pain, such as severe pain, abdominal muscle tension, should immediately go to the hospital for treatment, to eliminate appendicitis caused by aphids, peritonitis or other acute abdomen, aphid caused by itching of the perineum skin, and Symptoms of perineal fungal infection, allergies and eczema are similar; aphid urinary tract inflammation is similar to general urinary tract infection, and attention should be paid to the difference. Combined with age, disease characteristics and local signs, clinical diagnosis is more difficult, and perianal examination See aphids or eggs are direct evidence of a differential diagnosis.
