Trichuris
Introduction
Introduction to whipworm disease Trichuriasis is a common intestinal parasitic disease caused by the cecum, appendix and ascending colon of parasitic nematodes (Trichuri strichiura), which is widely distributed, especially in tropical and subtropical regions. It is widespread in China, especially in rural areas. The patients are mainly children, severe infection can affect the growth and development of children, mild to moderate infection can be asymptomatic; severe infections include diarrhea, blood in the stool, urgency, rectal prolapse, anemia and malnutrition. basic knowledge The proportion of illness: 0.055% Susceptible people: mainly children Mode of infection: intestinal parasitic infection Complications: peritonitis anemia urticaria
Cause
The cause of whipworm disease
(1) Causes of the disease
The first-ordered nematode (referred to as whipworm) belongs to the linear animal, the nematode, the whipworm, and the human being is the only natural host. The front body is 3/5 slender, flesh-colored, and the back end is obese, with a whip-like shape. The insects are 30 to 45 mm long and the tail is curled to 360°. The reproductive organs include bag-shaped testes, vas deferens, ejaculatory ducts, cloaca and spear-like thorns. The females are 35 to 50 mm long, and the rear end is obtuse, and the reproductive organs are There are ovaries, fallopian tubes, uterus and vulva openings at the front end of the obesity department.
The eggs are in the shape of a waist drum, with a mucus plug protruding from the inner layer at both ends, not colored, the egg shell has three layers, the outermost layer is a yolk membrane, which is brown, and the size of the eggs is (50-54) m × (22-23) Mm, excreted with feces, develops into a contagious period in warm, dark and moist soil, containing an active first-stage larva of the unskinned skin in the egg shell, which is swallowed by the digestive juice and in the small intestine. Hatching larvae and drilling into the small intestine and colonic crypts, and finally settled in the cecum and part of the large intestine epithelial cells, no longer moved to other parts, gradually developed into adults, about 2 months, adult life in the body 3 to 5 In the year, it is less resistant to dryness and heat than locust eggs; it does not develop into a contagious period in hard soil, dust, cinder, and garbage; it cannot survive under the influence of sunlight, cold, humus and chemicals, in dry manure. It only lives for a few days or weeks. The main mode of transmission is that the eggs in the feces contaminate the soil, and then the infected eggs are directly or indirectly passed through the hands and vegetables to cause infection, and people are not directly infected.
(two) pathogenesis
It is generally considered to include mechanical and allergic injury. The former may be the main cause of human whipworm disease. Adults are drilled into the cecum and colon epithelium to cause intestinal mucosal damage, while the worm stimulates mucosal plexus in the intestinal mucosa. Diarrhea and cramps.
Diffuse colitis is thought to be related to allergic reactions caused by whipworm infection, with characteristic eosinophils and Charcot-Ryden crystals in colonic exudates, Bawie et al. (1978) based on whipworm disease Growth retardation and clubbing occur, suggesting that the worm may be associated with an unknown factor.
According to electron microscopic observation, the growth and development of the mouse cecum in the cecum, through the action of the lysed tissue of the head of the worm, enter the intestinal epithelial cells, form a syncytium of the intestinal cells, and swallow the cellular components of the host, when the worm matures When the posterior part of the body protrudes or its tunnel ruptures and hangs in the intestine cavity, it is beneficial to mating and spawning. Microscopic examination reveals that the intestinal tissue inflammation is mild, but the intestinal wall cells are destroyed, and the intestinal villi are lost due to fibrillar fibers. Shortened, no obvious bleeding around the tunnel, and plasma cells, lymphocytes and eosinophils infiltrated between the crypts.
In patients with mild infection, whipworms often parasitize in the cecum and ascending colon; in severe infections, the transverse colon and descending colon may be involved, and even the rectum may have parasitic worms. Colonoscopy may reveal edema on the mucosal surface and increased blood vessels; in severe cases, there are Mucosal hemorrhage or ulceration, rectal involvement, mucosal edema and hemorrhage, pathological changes only found in the epithelial layer and lamina propria, intestinal wall crypts and intestinal glands hyperplasia, goblet cells normal or hyperplasia, large amount of mucus on the intestinal surface, surface epithelial exfoliation Rarely, mononuclear cells are seen in the lamina propria, eosinophil infiltration, severe infection can cause diffuse infiltration of eosinophils, and even deep into the submucosa.
Prevention
Whipworm disease prevention
Promote the treatment of fecal harmless treatment, strengthen the management of manure, pay attention to environmental sanitation, personal hygiene, and protect water sources.
Complication
Waspworm disease complications Complications peritonitis anemia urticaria
1. Urticaria.
2. Prolapse.
3. Anemia.
4. Even with appendicitis, peritonitis, intestinal obstruction and intussusception.
Symptom
Symptoms of whipworm disease Common symptoms, acute abdominal pain, low fever, nausea, diarrhea, edema, diarrhea
Although mild and moderately infected, it is more common in clinical practice, but generally has no significant symptoms. Occasionally, right lower quadrant pain, nausea, vomiting, low fever, etc., severe infections are more common in children, and have the following performances:
1 Gastrointestinal aspects: different degrees of congestion, edema, chronic bleeding, ulcer formation, patients with diarrhea, pus and blood, urgency and weight, rectal prolapse, some patients with symptoms of chronic appendicitis.
2 blood system: blood routine examination showed an increase in eosinophils, iron deficiency anemia, etc., severe anemia caused the heart to expand.
3 nervous system: often dizziness, dizziness, very few may have symptoms of meningitis, abdominal palpation often has obvious tenderness in the right lower abdomen.
Examine
Whipworm disease check
Blood routine attention to eosinophil count, small red blood cell low hemoglobin anemia, stool routine search for eggs or saturated salt water floating method to find eggs, if necessary, count eggs, rectal examination or prolapse on the rectum to see whip Adult adults can also be diagnosed.
The inspection methods include: direct smear method of saline; saturated saline flotation method; water-washing natural precipitation method, the main determination of infection degree can be applied to the quantitative plate-glycerin glass counting method (plus modified method), sigmoid colonoscopy or fiber colonoscopy It can be seen that the worm body is attached to the intestinal mucosa, mucus is visible next to the worm body, the mucous membrane is slightly congested and easy to get out of the car, and colonoscopy can also be used as a means of differential diagnosis to exclude other intestinal diseases, X-ray barium enema Check, using the gas double angiography method to find the shape of the light-transmitting insects coated with tincture.
Diagnosis
Diagnosis and identification of whipworm disease
Based on clinical performance and laboratory tests.
It should be noted that there is no difference between the identification of tsutsugamushi disease, hookworm disease and amoebic bowel disease. Although there is no difference between the shape of the pig whipworm and the human whipworm, the chromosome numbers of the somatic cells can be different. Identification with bacillary dysentery.
