阴道血吸虫病

　　1、发病原因

　　通常由皮肤黏膜接触含有血吸虫尾蚴的疫水而受到感染。

　　2、发病机制

　　血吸虫毛蚴头腺分泌毒素，引起急性炎症反应。在虫卵周围聚集大量细胞，细胞浸润的中央部分常发生坏死，使局部形成嗜酸性脓肿，继而发生黏膜破溃。有时可在会阴部见到瘘管，多数窦道可使病变形成蜂窝状特殊外观。还可引起血吸虫肉芽肿性湿疣。宫颈因血吸虫可引起鳞状上皮呈假上皮瘤样增生。病灶处形成瘢痕、溃疡及钙化。

　　1. Concurrent infection in other parts of the reproductive organs:It can affect reproductive function.

　　2. Concurrent systemic infection:Acute变态反应性症状 mainly characterized by fever, accompanied by abdominal pain, diarrhea, hepatosplenomegaly, and increased eosinophils.

　　3. Late-stage lesions:A syndrome mainly characterized by hepatosplenomegaly, ascites, portal hypertension, and esophageal varices at the lower end and gastric fundus due to collateral circulation formation. Late-stage patients may develop severe symptoms such as upper gastrointestinal bleeding and hepatic coma, leading to death.

　　4. In children and adolescents, severe infection can lead to hypoplasia of the anterior lobe of the pituitary gland, and other factors can affect growth and development and reproduction, leading to dwarfism.

　　Irregular vaginal bleeding, menorrhagia, dysmenorrhea, marked increase in leukorrhea, vaginal swelling and discomfort, with papules and sand-like plaques that can form into patches, presenting as polypoid or papillary hyperplasia. Sometimes, ulcers and scars may form, causing difficulty in sexual intercourse, pain during sexual intercourse, post-coital bleeding, and excessive vaginal discharge. The cervix, uterus, and fallopian tubes may also be involved, with thick spots on the mucosa appearing sandy-like and subsequently calcifying.

　　1. Individual protection:Avoid or reduce direct contact with epidemic water. Ten minutes before entering the water in the epidemic area, apply a 15% butyl phthalate emulsion and antilarval oil to the skin to prevent the tail larvae from penetrating the skin, which can maintain for 4 hours with a single application. Use protective equipment or medication to prevent the invasion of tail larvae into the human body. For example, wearing protective gloves, long rubber boots, and nylon protective pants.

　　2. Group protection:Eliminate larvae in water bodies in susceptible areas, strengthen the sanitation of drinking water in temporary residential areas for residents, and treat 0.5g of bleaching powder or 1g of calcium hypochlorite per 50kg of drinking water. It can be drunk after 30 minutes. Reduce water-related work by improving production methods; or use tools instead of manual submersion during water-related work, use waterproof gear, and reform production tools.

　　Strengthen the monitoring and management of key populations and personnel from epidemic areas: Those who enter infectious snail areas for fishing, grazing, water transportation, flood fighting and rescue operations, and those who temporarily reside on the embankments during the flood season should be registered and documented, and individual case records should be kept, especially for non-epidemic area personnel engaged in water-related work. They should be urged to take individual protective measures, keep records, and be provided with medication to ensure they do not develop acute infections after leaving. Pyrantel pamoate should be taken in a single dose of 40mg/kg approximately 4 weeks after first contact with epidemic water, or early prevention can be carried out with artemether or dihydroartemisinin 2 weeks after contact with epidemic water during the peak infection period.

　　The most fundamental method for preventing schistosomiasis is to eliminate Oncomelania hupensis. Methods of physical elimination of snails include soil burial, channel hardening, reclamation, water conservation and aquaculture, and burning to eliminate snails. It can also adopt methods of spraying and immersion to eliminate snails with drugs. It can also use the natural enemies of snails or other organisms, such as afforestation to suppress snails, to directly eliminate or disrupt the population balance, and achieve the goal of eliminating snails.

　　1, Hematology:Relative and absolute counts of eosinophils can increase significantly.

　　2, Parasitological examination:Perfectly intact eggs with tails or calcified eggs can be found in urine and feces; sigmoidoscopy can be performed to take a tissue section for examination of the intestinal mucosa, and eggs can be found. Local biopsy examination may be necessary if required.

　　3, Vaginal secretions:It can also detect eggs, and can assist in the diagnosis of female reproductive tract schistosomiasis by detecting eosinophil cationic protein (ECP) in vaginal secretions, and IgA.

　　4, Immunological examination:It can assist in diagnosis, including intradermal tests, delayed-type hypersensitivity skin tests, rosette formation tests, lymphocyte transformation tests, or complement fixation tests to detect immune function, as well as the ring precipitation test, enzyme-linked immunosorbent assay to detect specific IgG, IgM, and IgA, or indirect hemagglutination tests to detect antibodies, with a high positive rate, but be cautious of occasional false positives.

　　5, Human papillomavirus PCR (polymerase chain reaction) examination.

　　6, HIV antibody detection, HIV nucleic acid qualitative detection, HIV RNA quantitative determination.

　　No abnormal findings.

　　Pumpkin Seed

　　One, Functions and Indications

　　Used for tapeworm disease, schistosomiasis.

　　Two, Nutritional Value

　　The seeds of Cucurbita moschata, a vine plant of the Cucurbitaceae family. Cucurbita moschata is also known as melon, pumpkin. It is cultivated in all parts of China. The mature fruits are harvested in summer and autumn, the pumpkin is opened, the seeds are collected, the seed coat is removed, and they are dried or roasted. When eaten, the seed coat is usually removed and called pumpkin seed kernel.

　　Three, Properties

　　One, Sweet in taste and neutral in nature. It can invigorate the spleen and benefit the Qi, promote lactation, moisten the lungs, and expel worms.

　　Two, It contains abundant fatty oils (such as linoleic acid, oleic acid, etc. as glycerides), protein, carotene, vitamin B1, B2, C, cucurbitin, and other components.

　　Three, It has a significant anthelmintic effect on tapeworms and roundworms, and has a paralyzing effect on the middle and posterior segments of beef tapeworm or pork tapeworm. It can also inhibit and kill the larvae of Schistosoma japonicum in experimental mice, with a stronger effect on female worms. The effective ingredient for anthelmintics in this product is water-soluble cucurbitin.

　　Four, Uses

　　Used for spleen deficiency with malnutrition, emaciation and weakness; spleen deficiency edema; postpartum insufficient lactation;百日咳 whooping cough with dry throat; tapeworm, roundworm, and schistosomiasis.

　　Five, Usage

　　Raw chewing, stir-frying, powdering, or decocting into a decoction.

　　Pumpkin seeds can be used to treat schistosomiasis, but a larger dose needs to be taken.

　　Diet should be easy to digest and rich in nutrition.

　　For late-stage patients with portal hypertension and edema, it is advisable to follow a low-salt and soft diet.

　　First, traditional Chinese medicine treatment for schistosomiasis

　　Single and Compound Prescriptions

　　1. Prescription of pumpkin seed powder (Practical Internal Medicine of Traditional Chinese Medicine):Remove the shell, oil, and grind into powder the pumpkin seeds, 80 grams each time for adults, 3 times a day, for 4 weeks. It is suitable for killing parasites and removing toxins; side effects include dizziness, diarrhea, decreased appetite, etc., which usually decrease or disappear after continuous medication for 10 days.

　　2. Prescription of Brucea javanica (Practical Internal Medicine of Traditional Chinese Medicine):Take the shell off the Brucea javanica and take out the kernel, 10 grains each time for adults (about 0.4 grams in weight), put them into capsules and swallow, 3 times a day, for 40 days as one course. It is suitable for killing parasites and removing toxins.

　　3. Prescription of Gancao powder (Practical Internal Medicine of Traditional Chinese Medicine):Gancao powder, 10 grams each time, 3 times a day. It is suitable for fever reduction in the acute stage. After the fever subsides, the dose is halved and continued for another week.

　　Second, Western treatment methods for vaginal schistosomiasis

　　1. Treatment

　　Local symptoms of vaginal schistosomiasis improve significantly after antischistosomiasis drug treatment.

　　(1) The drugs recommended by WHO include: praziquantel (Praziquantel) as the first choice, 40mg/kg, one-day therapy, divided into three equal doses for oral administration. The cure rate is 85% to 95%. Metrifonate (Dichlorvos, Metrifonate) 7.5-10mg/kg, oral, once every 2 weeks, for 3 times in a row. The cure rate is 40% to 80%.

　　(2) Other drugs include potassium antimony tartrate, furazolidone, hexachloro-1,3,5-trichloro-2,4-dimethylbenzene, antimony sodium metanaphtholate, nitrothiazole, etc. It is now advocated to use drug combination therapy, praziquantel plus immunomodulators such as cyclosporin or Chinese herbal medicine Artemisia annua and its derivatives;

　　(3) The treatment principle is to disinfect locally, relieve itching, and prevent secondary infection. Add corresponding antibiotics for secondary infected patients.

　　(4) Skin granulomas formed in the late stage can be treated by electrocautery, microwave, CO2 laser, or surgical resection.

　　(5) If allergic reactions occur, antihistamines or corticosteroids should be administered.

　　2. Prognosis

　　Can be cured after active and standardized treatment.