【正文】 1．該患者可能從哪些途徑感染豬帶絳蟲的？2．該患者經(jīng)吡喹酮治療后，如何確定驅(qū)蟲療效?3．用什么藥物驅(qū)蟲可較好的確定驅(qū)蟲效果？4．該患者驅(qū)出成蟲后還應(yīng)注意什么問(wèn)題？病例十陳，女，28歲，江西人，南昌市郊務(wù)農(nóng)。豬肉菜肴為肉糜樣，發(fā)白，由當(dāng)?shù)氐穆榻奉惖淖髁虾望}、味精等攪拌而成，口感麻、辣、香、鮮。1. 此病例最終證實(shí)屬于哪種寄生蟲?。渴窃鯓痈腥颈静〉?？2. 為什么在糞便中查不到華支睪蟲蟲卵？有幾種可能性？3. 華支睪吸蟲病和肝炎的癥狀上有哪些相似之處？在診斷上如何鑒別？病例九李某，大學(xué)在讀學(xué)生，在某年十一月發(fā)現(xiàn)大便中帶有白色物，大小呈指節(jié)樣，見(jiàn)有多節(jié)相連或單節(jié)樣，有時(shí)白色節(jié)片樣物是破裂的，也有完整的單節(jié)片有微蠕動(dòng)。患者轉(zhuǎn)入肝炎科后行靜脈點(diǎn)滴促進(jìn)肝細(xì)胞生長(zhǎng)因子，口服保肝類藥物等，二周后復(fù)查功能仍為異常，疑為某寄生蟲病。以畏寒，發(fā)熱伴乏力1周為主訴入院。6月初突然痰中帶血絲、伴有盜汗，發(fā)現(xiàn)胸腔有胸水，施胸腔穿刺術(shù)，抽出淡黃色液體300ml，胸水涂片檢出抗酸分枝桿菌，結(jié)核菌PCR檢測(cè)陽(yáng)性。問(wèn)題：1．根據(jù)上述病史、體檢及化驗(yàn)結(jié)果，你懷疑患者是什么病？2．要確診此病，你認(rèn)為還應(yīng)當(dāng)作哪些檢查？3．可采取什么治療方法緩解病情，以進(jìn)一步確診疾?。坎±呋颊邉⒛?，男，50歲，浙江義烏縣防疫站醫(yī)師。腹軟，肝不腫大、無(wú)明顯壓痛。三天前在廠醫(yī)院就治，服用黃連素和克感敏3天，不見(jiàn)癥狀緩解。問(wèn)題：1．該病例在外院治療有什么教訓(xùn)可吸取？2．為什么該病例初步診斷是“下消化道出血”？3．為什么腸鏡檢查時(shí)會(huì)在回腸未端顯示有鉤蟲寄生？病例四A 3yearold girl was brought to the emergency a general hospital following a 3week history of nausea, poor appetite, and abdominal pain. She had not had any bowel movements for the last 2 days.The patient was of Mexican origin and had recently moved from Mexico with her mother to South Texas.PHYSICAL EXAMINATIONVS: T 37℃, P 110/min, R20/min, BP 102/54mmHgPE20070807開始驅(qū)蟲治療甲苯咪唑： 一日兩次，口服。病理：（回盲瓣）腸粘膜慢性炎，間質(zhì)內(nèi)見(jiàn)嗜酸性粒細(xì)胞浸潤(rùn)。糞常規(guī)：黃色，隱血陽(yáng)性。既往曾因“貧血”在當(dāng)?shù)蒯t(yī)院就診，予驅(qū)蟲治療，具體不詳。因納差、乏力、上腹不適、反復(fù)黑便2月于20070802入院。問(wèn)題：1．根據(jù)上述病史，寫出診斷及診斷依據(jù)。20次/分，Bp既往身體健康，無(wú)慢性腹瀉史，無(wú)藥物過(guò)敏史。 病史：患者于一個(gè)月前外出旅游，曾在當(dāng)?shù)仫嬍硵偩筒投啻巍ｓw檢及化驗(yàn)：貧血外貌，血色素105g/L，1012 /L（260萬(wàn)/mm3），1010 /L(10400/mm3 )，出凝血時(shí)間正常，大便黑褐色，隱血“+++ ”，紅細(xì)胞“+”，涂片發(fā)現(xiàn)少許某寄生蟲蟲卵。因經(jīng)?？人砸约翱妊到?個(gè)月，大便有時(shí)呈黑便，消瘦一個(gè)月余入院治療。經(jīng)當(dāng)?shù)匦l(wèi)生院檢查先后擬診為“支氣管炎”“缺鐵性貧血，胃癌？”治療2個(gè)月余終不見(jiàn)好轉(zhuǎn)。腹軟有明顯壓痛，肝膽未及。 5天前，患者突感右下腹疼痛，腹瀉，大便每日10余次，為膿血粘液便，量大，腥臭，伴明顯里急后重感，曾自行口服黃連素止瀉，腹瀉無(wú)好轉(zhuǎn)。 體檢：℃,120/80mmHg，無(wú)皮疹和出血點(diǎn)，淺表淋巴結(jié)未觸及，鞏膜不黃，咽()，心肺()，腹平軟，右下腹輕壓痛，無(wú)肌緊張和反跳痛，未觸及腫塊，肝脾未觸及，腹水征()，腸鳴音稍活躍，下肢不腫。2．寫出該病與常見(jiàn)的菌痢的主要鑒別診斷（列出兩者的主要鑒別點(diǎn)）。上腹不適多于進(jìn)食后緩解，黑便多為成形黑便，每日一到二次。否認(rèn)其他病史。肝功能：總蛋白：57g/L，白蛋白：32g/L，余正常。20070807 胃鏡食管未見(jiàn)異常，胃粘膜貧血相，十二指腸球部未見(jiàn)潰瘍，降部見(jiàn)數(shù)條白色線狀蟲體，性狀同腸鏡下所見(jiàn)。同時(shí)予鐵劑、維生素C治療貧血。:Young child in moderate distress due to abdominal pain. Abdomen was distended and mildly tender.LABORATORY STUDIESBloodHematocrit: 38%WBC: 4500/μLDifferential: 62% PMNs, 23% lymphs, 12% eosinophils(eosinophilia)Serum chemistries: NormalImagingXrays of her abdomen were consistent with intestinal obstruction.Diagnostic WorkUpTable 491 lists the likely causes of illness (differential diagnosis). Intestinal worm infection was considered based on clinical features and xray evidence. Diagnosis is confirmed by identification of ova and parasites by microscopy of trichrome or iodinestained concentrated fecal specimens. TABLE49－1 Differential Diagnosis and Rationale for Inclusion (consideration)AppendicitisIntestinal helminth infection Ascaris lumbricoides Schistosoma spp Taenia spp Trichuris trichiuraSmall bowel obstruction from volvulusRationale: Abdominal symptoms with eosinophilia have a relatively limited differential, mainly parasitic infection. The various causes can be reliably determined only through stool examination for ova and parasites. Noninfectious causes may also cause similar symptoms but will not demonstrate eosinophilia.COURSEThe patient was admitted to the hospital and put on intravenous hydration. Stool examination revealed characteristic nematode eggs.病例五A 36yearold man presented to the emergency department of a general hospital with a 10day history of intermittent diarrhea and tenesmus, with blood and mucus visible in the stool. He had just returned from a working trip to India, where he had visited a rural town in the last week of his trip.PYSICAL EXAMINATIONVS: T ℃, P 96/min, R 16/min, BP 130/80 mmHgPE: Illappearing male in mild distress。近日因全身肌肉酸痛加劇，吞咽困難，體溫明顯升高而入院治療。四肢肌肉和臉部肌肉有明顯壓痛，但未見(jiàn)有包塊。病人主訴是：因間歇性咳嗽1個(gè)月余伴右側(cè)胸痛1周，加重3d為，于1996年5月2日急診入院。既往史從事血吸蟲病、肺吸蟲病流行病學(xué)調(diào)查及病原體分離工作20年；有食腌蟹、腌蝦等習(xí)慣。患者于1周前因飲少量啤酒后感到上腹部不適，飽脹感；當(dāng)晚出現(xiàn)畏寒、發(fā)熱，體溫達(dá)38℃，無(wú)咳嗽、胸痛及咯血等癥狀。追問(wèn)病史，患者喜愛(ài)釣魚和下河捕魚，但從未曾生食過(guò)魚。該患者從糞便中取出白色節(jié)片后去醫(yī)院就診。體格檢查：頸軟，未觸及腫大淋巴結(jié)；心、肺、血壓均正常；腹軟，無(wú)壓痛和包塊。婚后二年，近來(lái)停經(jīng)一個(gè)多月，身感不適，估計(jì)有身孕，在江西某市婦幼保健院產(chǎn)科就診。X線檢查：未見(jiàn)胎兒有鈣化樣病灶。 組織內(nèi)寄生蟲病例十一徐，男，50歲，上海人，上海市某公司經(jīng)理，因高燒入某市級(jí)醫(yī)院治療。入院后每天都有不規(guī)則發(fā)熱，頭痛癥狀明顯并逐漸加重，入院前四天體溫在37oC~，檢測(cè)顱內(nèi)壓有些增高。入院第7天晚上，患者被診斷為腦型瘧搶救無(wú)效而死亡。體檢：雙下肢肌張力增高, 雙側(cè)眼底可見(jiàn)視乳頭水腫, 考慮腦室端已堵塞。手術(shù)及病理：術(shù)中可見(jiàn)雙側(cè)側(cè)腦室內(nèi)巨大囊腫,通過(guò)擴(kuò)大的室間孔相連,呈啞鈴形,囊壁乳白色半透明,與腦室壁無(wú)粘連,囊液淡黃色透明、約40ｍｌ,分流管腦室端位于囊外,引流孔已全部堵塞,與腦室壁粘連。發(fā)病30天后，于9月15日入院治療。入院后給予抗菌素治療， g/d，靜脈滴注1周，高熱持續(xù)不退。2．進(jìn)一步確診該寄生蟲病可用什么實(shí)驗(yàn)診斷?3．分析該患者臨床癥狀產(chǎn)生的病理學(xué)依據(jù)。于1998年4月以“雙飛陰影待查，先天性肺囊腫帶排除”入院治療。病人入院后痰量增加，辦左側(cè)胸痛和低熱。術(shù)后給予阿苯達(dá)唑600mg/d治療，口服一年，隨訪至今健康。 several seizures had occurred over the past 2 days.She had been HIV positive for 3 years and had been diagnosed with AIDS a year before the current espisode. She had been on HIV therapy, but was currently failing her regimen. She was also on aerosolized pentamidine because of a bactrim allergy. Her brother, who brought her to the ED, could not recall any history of seizures.PHYSICAL EXAMINATIONVS: T 38℃ , P 86/min, R