Expert consensus on diagnosis and treatment of food-borne parasitic diseases (2023)

doi:10.12140/j.issn.1000-7423.2023.06.001

Abstract

Abstract:

Food-borne parasitic diseases caused by ingesting food and water containing infective parasites are still common parasitic diseases that are easily misdiagnosed and mistreated in clinical practice. With the participation of multi-disciplinary experts, and in the light of the latest research results at home and abroad, based on factors other than the quality of evidence (economics, patient preferences and values, trade-offs, accessibility, fairness, acceptability, etc.), the level of recommendation and the quality of evidence in evidence-based medicine were assessed using the World Health Organization-recommended evidence quality classification and strength of recommendation system, and a consensus of 24 items was reached to guide and improve the comprehensive diagnosis and treatment of food-borne parasitic diseases for clinical medical staff.

Key words: Food-borne parasitic diseases, Diagnosis and treatment, Consensus

CLC Number:

Expert Group of National Center for Infectious Diseases, National Center for Infectious Disease Medicine. Expert consensus on diagnosis and treatment of food-borne parasitic diseases (2023)[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2023, 41(6): 653-668.

Figures/Tables 5

虫种	病原学	免疫学	分子生物学	影像学	病理组织学
隐孢子虫	粪便涂片染色，查卵囊（金胺‐酚染色法、改良抗酸染色法、金胺‐酚改良抗酸染色法）	血清IFA、ELISA；粪样IFT（间接荧光抗体试验）、ELISA	基因检测PCR、DNA探针
肉孢子虫	粪便直接涂片、蔗糖浮聚法、硫酸锌浮聚法查卵囊或孢子囊				肌肉活检查肉孢子虫
贝氏等孢球虫	粪便直接或浓缩后涂片、抗酸染色或改良抗酸染色				十二指肠黏膜活检查卵囊
微孢子虫	粪便直接涂片，尿液、十二指肠液、胆汁标本吉氏染色、韦伯染色和Uvitex2B染色镜检查成熟孢子	血清ELISA、IFA	基因检测PCR
华支睾吸虫	粪便直接涂片、定量透明厚涂片法，集卵法，十二指肠引流胆汁检查虫卵	ELISA、IHA、IFA		B超、CT
布氏姜片吸虫	粪便直接涂片、浓集法、定量透明厚涂片法查虫卵	ELISA、IFA
肝片形吸虫	粪便、十二指肠引流液查虫卵	ELISA、IHA、IFA
卫氏并殖吸虫	痰、粪便查虫卵	ELISA		胸肺型、脑脊髓型患者	皮下包块查虫体或虫卵
斯氏并殖吸虫		ELISA			皮下包块查童虫
异形吸虫	粪便涂片法及沉淀法查虫卵
棘口吸虫	粪便涂片法及沉淀法查虫卵
徐氏拟裸茎吸虫	驱虫治疗后粪便查虫卵
后睾吸虫	粪便涂片法及沉淀法查虫卵
曼氏迭宫绦虫	粪便查虫卵	ELISA		脑裂头蚴CT	局部组织查裂头蚴
阔节裂头绦虫	粪便查虫卵
链状带绦虫	粪便查虫卵、孕节	IHA、ELISA、ELIB		脑和深部组织用X线、B超、CT、MRI等	皮下包块活检；眼底镜检查眼部囊尾蚴；
肥胖带绦虫	粪便查虫卵、孕节；肛门拭子查虫卵
亚洲带绦虫	粪便查虫卵、孕节，驱虫后粪便查虫体		基因检测PCR
旋毛虫	食剩肉类镜检、偶在脑脊液查幼虫；	IFA、ELISA、蛋白质免疫印迹（Western blotting）			肌肉活检查幼虫囊包
广州管圆线虫	脑脊液、眼部查幼虫、成虫	ELISA、IFA、金标法	CSF检测核酸片段micoRNA	MRI	眼底镜检查眼部幼虫
东方毛圆线虫	粪便饱和盐水浮聚法查虫卵
棘颚口线虫		ELISA			病变组织活检查虫体
兽比翼线虫	肺泡灌洗液、痰液查成虫及虫卵				气管壁上检获成虫
异尖线虫		ELISA			胃内检获幼虫

病原体	推荐方案
病原体	首选方案	备选方案
溶组织阿米巴病
无症状排包囊者	巴龙霉素25~35 mg/（kg·d），口服，3次/d × 7 d或双碘喹啉650 mg，口服，3次/d × 7 d
腹泻/痢疾患者：轻/中症患者	甲硝唑500~750 mg，3次/d × 7 d或者替硝唑2 g，1次/d × 3 d，随后改用巴龙霉素25~35 mg/（kg·d），3次/d × 7 d或双碘喹啉650 mg，3次/d × 20 d以清除肠道内包囊
重症或肠外阿米巴感染者，如肝脓肿	甲硝唑750 mg静脉滴注后改口服3次/d × 10 d或替硝唑2 g，1次/d × 5 d，随后改用巴龙霉素25~35 mg/（kg·d），3次/d × 7 d或双碘喹啉650 mg，3次/d × 20 d
刚地弓形虫病
伴淋巴结肿大的急性患者	除非有严重/持续性症状或重要器官受损的证据，否则无需特殊治疗
活动性脉络膜视网膜炎；脑膜炎；免疫抑制剂引起的抵抗力下降患者	乙胺嘧啶（200 mg 1次/d × 1 d，然后50~75 mg，1次/d）+ 磺胺嘧啶（1~1.5 g，4次/d） + 亚叶酸（5~20 mg，2次/周），用药至症状/体征消失后1~2周；乙胺嘧啶停药后继续用亚叶酸1周
孕妇急性感染	若妊娠< 18周：螺旋霉素1 g，每8小时1次至妊娠16~18周；若羊水PCR阴性可停药。若PCR仍阳性按下列方案治疗：若妊娠> 18周和胎儿感染（经羊水PCR阳性证实）；乙胺嘧啶（50 mg，每12小时1次 × 2 d，然后50 mg/d） + 磺胺嘧啶[75 mg/kg × 1次，然后50 mg/kg，每12小时1次（最大剂量4 g/d）]+ 亚叶酸（10~20 mg，1次/d），至少治疗4周或至分娩
线虫类食源性寄生虫病
广州管圆线虫-引起嗜酸粒细胞脑膜炎	轻中度感染：泼尼松60 mg/d × 14 d可减轻头痛，减少腰穿次数	阿苯达唑15 mg/（kg·d）+ 泼尼松60 mg/d × 14 d，可减轻头痛，减少腰穿次数
东方毛圆线虫病	双氯萘酸塞嘧啶11 mg/kg，1次，或阿苯达唑400 mg，1次/d × 10 d或甲苯达唑500 mg，2次/d × 10 d	阿苯达唑400 mg，1次
旋毛虫病	阿苯达唑400 mg，2次/d × 8~14 d	甲苯达唑500 mg，3次/d × 10 d
吸虫类食源性寄生虫病
华支睾吸虫病	吡喹酮25 mg/kg，3次/d × 2 d	阿苯达唑10 mg/（kg·d）× 7 d
布氏姜片吸虫病	吡喹酮25 mg/kg，3次/d × 1 d	硫双二氯酚：50 mg/（kg·d），睡前半空腹1次顿服或连服2 d
肝片形吸虫病	三氯苯达唑10 mg/kg，1次；治疗失败者20 mg/kg，1次	硫双二氯酚： 30~50 mg/（kg·d），分3次服，隔日1次，15个治疗日为1疗程；50 mg/（kg·d），连服10 d
卫氏并殖吸虫病	吡喹酮25 mg/kg，3次/d × 2 d	三氯苯达唑10 mg/kg，2次/d × 1 d
绦虫类食源性寄生虫病
肠道绦虫病	吡喹酮5~10 mg/kg，1次（儿童和成人）	氯硝柳胺2 g，1次
神经囊尾蚴病
脑实质囊尾蚴病	阿苯达唑15 mg/（kg·d）+ 吡喹酮50 mg/（kg·d）+ 地塞米松0.1 mg/（kg·d）× 10 d。抗寄生虫治疗前一天启动糖皮质激素治疗，疗程10 d。	阿苯达唑800 mg/d + 地塞米松0.1 mg /（kg·d）
蛛网膜下腔囊尾蚴病	阿苯达唑15 mg/（kg·d）（最大量1 200 mg/d）+ 糖皮质激素剂量同前。
脑室内囊尾蚴病	无论有无梗阻，均可选择神经内镜取出病灶。若无法手术，可用阿苯达唑 + 地塞米松
曼氏迭宫绦虫病	外科切除。无需驱虫药物。皮下包块可予40%的乙醇普鲁卡因注射

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来源分类	临床常见疾病
肉源性寄生虫病	猪带绦虫病，猪囊尾蚴病，牛带绦虫病，亚洲带绦虫病、旋毛虫病，弓形虫病，肉孢子虫病等
鱼源性寄生虫病	华支睾吸虫病，东方次睾吸虫病，日本棘隙吸虫病，异形吸虫病，异尖线虫病，膨结线虫病，裂头绦虫病，颚口线虫病等
甲壳动物源性寄生虫病	卫氏并殖吸虫病，斯氏狸殖吸虫病等
两栖爬行动物源性寄生虫病	舌形虫病，曼氏迭宫绦虫病，裂头蚴病等
节肢动物源性寄生虫病	西里伯瑞列绦虫病，长膜壳绦虫病，犬复孔绦虫病、巨吻棘头虫病，管线虫病等
植物源性寄生虫病	姜片吸虫病，片形吸虫病等
软体动物源性寄生虫病	广州管圆线虫病，拟裸茎吸虫病，棘口吸虫病等
水源性寄生虫病	隐孢子虫病，贾第鞭毛虫病，溶组织阿米巴病等

推荐强度	定义
强烈推荐（Ⅰ级）	明确显示干预措施利大于弊或弊大于利
有条件推荐（Ⅱ级）	利弊不确定或无论证据级别的高低均显示利弊相当

证据质量级别	定义
高质量（A）	对估计的效应值非常确信，估计值接近真实值，进一步研究基本不改变该估计效应值的可信度
中等质量（B）	对估计的效应值确信程度中等，估计值有可能接近真实值，但仍存在二者不相同的可能性，进一步研究有可能改变该估计效应值的可信度
低质量（C）	对估计的效应值确信程度有限，估计值与真实值可能不同。进一步研究极有可能改变该估计效应值的可信度
极低质量（D）	对估计的效应值几乎不能确信，估计值与真实值很可能完全不同。进一步研究有可能不确定该估计效应值的可信度