vulvar schistosomiasis
Introduction
Introduction to vulvar schistosomiasis Vulvar schistosomiasis is a part of the systemic disease of schistosomiasis, which causes schistosomiasis in the portal vein and mesenteric arteries of humans and animals, commonly known as "big stomach disease." It is characterized by hepatosplenomegaly, symptoms of dysentery and advanced cirrhosis. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: fecal spread Complications: gastrointestinal bleeding, hepatic encephalopathy
Cause
Causes of vaginal schistosomiasis
Causes:
Vulvar schistosomiasis is caused by infection of other parts of the body and infection with vulva. There are 5 species of schistosomiasis in the human body: Schistosoma japonicum, interspersed with schistosomiasis, Schistosoma japonicum, Schistosoma mansoni, Schistosoma japonicum, only Schistosoma japonicum in China, this worm In 1904, the Japanese Gui Tian first reported in Japan, hence the name Schistosoma japonicum, in addition to parasitic in the human body schistosomiasis, there are still avian and animal schistosomiasis, a wide variety, the actual poultry schistosomiasis cercariae dermatitis may be more widespread in China, The main reports in China have been: 1 P. sinensis; 2 P. sinensis; 3 eye worms; 4 T. sinensis T. sinensis subspecies; 5 G. sinensis; 6 T. sinensis ; 7 Cheng's Donghua fluke.
The complete life history of schistosomiasis is a large cycle between humans or other mammals and the natural environment and snails. The life history of schistosomiasis includes seven periods: eggs, buttercups, mother baboons, scorpions, scorpions, worms, adults, etc. The feces of people or animals infected with schistosomiasis contain a large number of schistosomiasis eggs, and the eggs hatch in the water, and the ranunculus encounters the snails and drills into the snails, and develops into a scorpion in the body, and the snails meet the water, and the snails meet the water. Drilled out and distributed on the surface of the water. At this time, people are exposed to the infected water, and the tail scorpion penetrates into the skin, causing dermatitis of the tail, waiting for the machine to penetrate into the human or mammal, and developing into an adult. The adult is produced in the small blood vessels of the human or animal intestinal wall. Eggs, eggs are again discharged with the feces, human schistosomiasis drilled into the skin of the tail scorpion to remove the tail and body of the cortex developed into a child worm, with blood flow or lymph to the right heart, lung, then to the left heart, and then to the mesenteric vein The portal vein develops into an adult and begins to lay eggs. The eggs are mainly deposited in the liver and colon. It is the main cause of schistosomiasis. The eggs are excreted with the stool and begin to breed. In the beginning, the lifespan of schistosomiasis in the human body can be as long as 30 to 40 years.
The animal's schistosomiasis is the feces of animals, animals and other animals, which discharge the eggs into the water. The hatchlings are plucked into the paddy fields, and the cone snails (radish snails) in the rivers breed in the body. After 1 to 2 months, a large number of cercariae are produced, floating in the water. At this time, if the human tail sputum can be attached to the human skin by the suction cup of the abdomen, causing a local inflammatory reaction, the cercariae of the animal schistosomiasis is penetrated into the skin is a mistake, and it will not continue to develop parasitism in the human body.
Pathogenesis:
Early dermal edema, lymphocytic and neutrophil infiltration, eosinophil infiltration in the late stage, within 24 hours after the invasion of the cercariae, especially within 2 ~ 3h can be found in the skin.
Prevention
Vulvar schistosomiasis prevention
1. The prevention of this disease is mainly to cure schistosomiasis patients, eliminate the source of infection, strengthen the management of feces, eliminate snails, snails and snails; strengthen personal protection and other links, the Ministry of Health formulated a major epidemic of schistosomiasis in 2003. Emergency treatment plan (Trial), weekly report and zero report on the epidemic situation of acute infection of schistosomiasis in severely affected areas, emergency plan requirements, in the event of schistosomiasis outbreak and major emergencies, the epidemic situation may be based on the epidemic situation and To control the need of outbreaks, set up a leading group for emergency response work; the health administrative department (blood defense department) should set up a technical guidance group for epidemic emergency treatment, which is attended by schistosomiasis, health supervision and other relevant medical institutions, when an acute schistosomiasis outbreak is found or When the first case of local infection is found in a previously unaffected area, the bloody defense, health care, and health and epidemic prevention personnel performing the duties shall report to the local schistosomiasis (disease control) agency as soon as possible, and the latter report to the higher authorities, in the schistosomiasis In the peak period of infection from June to October, the establishment of acute patient outbreak days and scattered Patients weekly system.
2. Protection
(1) Personal protection: the subject is exposed to infected water, the focus is on people from non-schistosomiasis-affected areas. Apply 15% butyl phthalate emulsion and anti-mite oil to the skin 10 minutes before the sewage in the endemic area to prevent cercariae. Drill into the skin and apply it once for 4 hours. In addition, 15% to 20% rosin alcohol or 30% rosin ointment also has a good protective effect.
(2) Group protection: water body mites for the susceptible areas outside the area, and strengthen the sanitation treatment of drinking water in the temporary residence of residents. Each 50kg of drinking water plus bleaching 0.5g or bleaching powder 1g for treatment, 30min after drinking, Small waters and beaches with snails distributed near the temporary residence of residents can be treated with niclosamide to kill cercariae and snails. The spraying dose is 2~3g/m2, and the dipping dose is 2~3g/m3.
3. Carry out early treatment or preventive medication: the time of early treatment should be carried out in the first contact with the infected water for about 4 weeks, the dose of praziquantel is 40mg/kg, or 2 weeks after exposure to the infected water at the peak of the infection with artemether or blue. Artesunate is used for early prevention.
4. Strengthen the monitoring and management of key populations: the people from the affected areas are screened by serological methods, and the positive ones are treated with praziquantel 60mg/kg, 2 days of therapy, and enter the infectious snail area for fishing and grazing during the season. Water transport and flood fighting and rescue operations, as well as those temporarily living on the levee during the flood season, should be registered and recorded, and the case records should be recorded. Especially for the foreign water operators in non-endemic areas, they should be urged to make personal protection and make records. And distribute the drug to ensure that it does not develop an acute infection after leaving.
5. Raise the awareness of the people's disease prevention: promote safe water use, not in the snail waters for laundry, swimming, water play, fishing and shrimp production, living activities, production, life and disaster relief must be in contact with the infected water, Apply protective agents to exposed areas of the body before exposure to contaminated water.
Complication
Vulvar schistosomiasis complications Complications, digestive tract hemorrhage, hepatic encephalopathy
Patients with advanced schistosomiasis often have gastrointestinal bleeding and hepatic encephalopathy.
Symptom
Vulvar schistosomiasis symptoms Common symptoms Itchy pseudotuberculous nodules Abdominal pain Lymph node swelling Herpes bloating splenomegaly Pustular diarrhea
After 5 to 30 minutes after drilling into the skin, the cercaria can form a temporary edematous rash at the invasive site. It can subside after 1 to 2 hours, and soon there will be a large reddish papule or a herpes on the needle. There is a small defect in the center, scattered or densely distributed. Local itchiness, especially at night, often scratching or secondary infection to form pustules, rashes are mostly limited to contact with water, generally in the upper and lower limbs water-immersed parts, a few can also be generalized, about 3 days of inflammation up to the most The peak, 1 to 2 weeks can gradually subside. If it is human schistosomiasis, the cercariae that penetrates into the skin can enter the lungs and then enter the bloodstream. Due to the damage of the egg toxin and tissue, the heterosexual protein reaction can occur, and there is fever and abdominal pain. , diarrhea, joint pain, swollen lymph nodes, urticaria or angioedema, increased neutrophils and eosinophils in the blood, the degree of response varies from person to person, some people are not sensitive to cercaria invasion, The symptoms are mild. Those who have been infected in the past have a higher response than those who are new.
In areas where schistosomiasis is endemic, schistosomiasis granulomatous genital warts of the perineum and external genitalia are also common in the perineal sputum. In addition, ectopic schistosomiasis is still seen, often oval in the trunk, mung bean large; hard papules, The surface is dry and desquamate, pigmentation, and the eggs are deposited on the local skin.
Children or adolescents may develop growth and development disorders after infection with schistosomiasis, such as short stature, lack of sexual organs, and no fertility.
Examine
Examination of vulvar schistosomiasis
Eosinophils in blood routine white blood cells, blood coagulation, enzyme labeling, latex and other serum immunoreactivity; in the secretions, urine, stool can be found in eggs.
B-ultrasound can be seen in hepatosplenomegaly.
Diagnosis
Diagnosis and diagnosis of schistosomiasis
Standards for confirmed cases:
1. A history of exposure to infected water from 2 weeks to 3 months before onset.
2. Fever, liver enlargement and peripheral blood eosinophilia are the main features, accompanied by tenderness in the liver area, splenomegaly, cough, bloating and diarrhea.
3. Check for schistosomiasis eggs or donkeys.
It should be differentiated from vulvar tsutsugamushi, vulvar amebiasis and insect bite dermatitis, papular urticaria.
