Blue-grey or black spots on the whites of the eyes

Introduction Triangular, round or half-moon blue, gray or black spots appear white in the eye are a common symptom of intestinal tsutsugamushi. Ascariasis is the most common parasitic disease caused by parasitic nematodes (Ascaris lumbricoides) parasitic in the human small intestine or other organs. The domestic epidemic is widespread, and the incidence of children is much.

Cause

The cause of white-blue-grey or black spots on the eyes

[pathogen]

Ascarislumbricoides Linnaeus (1758) is abbreviated as aphids, and the human body ingests infected eggs during the infection period.

[pathological changes]

X-ray examination of some patients with larval pathogenicity shows invasive lesions, and the lesions often have migration phenomenon; adults can damage intestinal mucosa, urticaria, itchy skin, angioedema, conjunctivitis, suppurative bile duct Inflammation, cholecystitis, and even bile duct necrosis, perforation, and volvulus and intestinal necrosis.

Often caused by eating cold vegetables, melons, or other unclean things that are contaminated with locust eggs. The mites are parasitic in the small intestine, disturbing the spleen and stomach, and sucking the water valley. Because aphids have a warm temperature, aversion to cold, heat, good sputum, good at drilling, so when the spleen and stomach dysfunction, or systemic febrile illness, the mites are easy to smash in the abdomen and cause a variety of illnesses . If the mites are drilled into the biliary tract, the cardia, or the number of mites are large, and tangled in the intestine, a variety of lesions and symptoms appear.

(1) Causes of the disease

1. Morphological characteristics: The adult mites are long cylindrical, like sputum, reddish when fresh, yellow-white after death. Both male and female, the body shape is tapered toward the ends of the head and tail, the tail is blunt-conical, and there are obvious white lateral lines on both sides. The male is short and thin, about 15 to 31 cm long, the widest point is 2 to 4 mm in diameter, and the tail end is curled to the ventral surface; the reproductive organs are single-tube type, the second half of the worm body is coiled, and the ejaculatory duct is opened in the cloaca; There is a spurting sac on the back of the back end, and there is a pair of nearly equal-shaped rod-shaped thorns in the sac; the number of anterior papilla is more, arranged in parallel four rows, and there are four double mastoids and six single breasts behind the anus. Sudden. The female is thick and long, about 20-35cm long (up to 49cm), 3-6mm in diameter, straight at the end; the genital organs are double-tube type, and the second-level reproductive organs are coiled around the back 2/3 part of the worm The uterus is thick and tubular, each uterus can be 200mm long. Each group of ovaries and fallopian tubes is about 1250mm long. The vulva is located at the junction of the first 1/3 and the middle 1/3 of the worm. The number of eggs in the uterus can reach 27 million. The number of eggs laid is about 13 to 360,000 / d. The fertilized egg is elliptical, about (45 ~ 75) m × (35 ~ 50) m, the egg shell is transparent and thick; the unfertilized egg is narrow and long, and there are unequal refractive particles. The fertilized egg discharge rate is 45% to 60%, and becomes a infected egg after development. Unfertilized eggs have no developmental capacity and are not contagious.

Ascaris eggs have strong resistance to the outside world. It can be produced for about 2 years at 5 to 10 °C, 3 months for hypoxia, and 2 to 3 weeks at 22 °C. It can survive for about 6 years in moist, loose, sandy soil. It can survive for more than 1 year in the pit. Ascaris eggs can tolerate general chemical disinfectants. Under 30 °C environment, sulfonamide (about 2%) and ammonia water do not affect the development of eggs. Eggs cannot be killed by seasonings such as soy sauce, vinegar and pepper, but are sensitive to temperature, and can be killed by direct sunlight or temperatures above 40 °C. In high temperature, dry environment or heavy rain, the survival time of eggs is short.

2. Life history: The mites are parasitic in the small intestine of the human body, with more jejunum, followed by ileum, and few parasitic in the duodenum and stomach. The number of parasitic insects varies greatly, with a few fewer, dozens more, and occasionally more than 2,000. The aphids have no intermediate host. After the males and females mate, the females produce fertilized eggs and excrete them with the feces. In warm, moist, oxygen-rich soil, they develop into aphids in about 2 weeks, and then the first molting in the first week. After that, it is the infected egg. In the infected period, the eggs cannot hatch outside. When they are swallowed, most of them are killed by stomach acid and a few enter the small intestine. The aphid in the infected egg of the small intestine releases the hatching solution (containing lipase, chitinase and protease), and after the egg shell is digested, the aphid breaks out of the shell. Hatched aphids invade the intestinal mucosa and submucosa, enter the vein through the liver, inferior vena cava to the right heart; or through the mesenteric lymphatic vessels, thoracic duct, subclavian vein to the right heart, and then through the pulmonary artery, through the pulmonary microvasculature into the alveoli Here, the 2nd and 3rd mink are performed here. The mites move up the bronchus and trachea to the epiglottis. If the mites are swallowed, pass through the stomach to the small intestine, and develop into a worm in the small intestine after the fourth molting, and gradually develop into an adult. It takes about 2 months from the swallowing of the infected eggs to the first time for the adults to lay eggs (Figure 1). Under normal circumstances, adults live in the small intestine for about 1 year, and the elderly can live for more than 4 years. After the adult is excreted, the generation time is short.

(two) pathogenesis

1. Pathogenic effects of larvae: Aphid larvae can cause mechanical damage to the intestine, liver, lung, microvessels and lymphoid tissues during migration, or can cause inflammatory reactions due to antigen-antibody reactions, metabolites or larval death. Large numbers of larvae migrate to the lungs, which can damage the pulmonary microvasculature, causing hemorrhage, edema, and a large amount of eosinophils and neutrophils infiltrating around the alveoli and bronchioles. In severely infected patients, lung lesions can be fused into patchy, bronchial mucosal inflammatory exudation and increased secretion. Bronchospasm can also occur, bronchioles and bronchiectasis, larvae can be seen in the bronchi.

2. The pathogenic role of adults: Aphid adults are parasitic in the small intestine, mainly in the upper part of the jejunum and ileum. Aphids can produce a variety of toxins such as hemolysin, allergens, endocrine toxins, neurotoxins, and mechanical or chemical stimuli, the secretion of digestive substances by the worms and damage to the intestinal mucosa, causing local mucosal epithelial cells to fall off or mildly. Inflammation. Clinically, there may be intermittent umbilical pain, dyspepsia, vomiting, diarrhea or constipation and other gastrointestinal disorders.

Aphids feed on the semi-digested material in the human intestinal lumen; they also secrete digestive enzymes to digest and dissolve the intestinal mucosa as food; aphid metabolites can stimulate and damage the local intestinal mucosa, or cause spasmodic contraction and smooth muscle ischemia. Therefore, a large number of parasitic mites can cause digestive and absorption dysfunction, especially affecting children's absorption of protein, sugar, fat and vitamins, malnutrition, and even developmental disorders.

If there are a large number of mites in the small intestine, they can entangle with each other to cause incomplete intestinal obstruction, which is manifested as abdominal pain, abdominal distension, and stop of defecation. The most common site of obstruction is the end of the ileum or the ileocecal area. A few severe cases can be complicated by intestinal necrosis, intussusception, and intestinal torsion.

Aphids are accustomed to drilling, often causing ectopic damage. When an adult drills into the common bile duct, often only the first half enters the common bile duct, while the latter half remains in the duodenum. Invasion of locusts varies from one to several, and many can reach 10 to 100, with more females. Due to severe cramps caused by Oddi's sphincter and common bile duct fistula, secondary infection may cause cholangitis or liver abscess. Dead aphid fragments can become the core of sediment-like gallstone formation. Aphids can penetrate into the pancreatic duct and can cause bloody necrotizing pancreatitis; drilling into the appendix can cause acute appendicitis, or perforation of the appendix. If the mites penetrate the throat or bronchi, it can cause obstruction and suffocation. Females invade the liver, the abdomen or the lungs to excrete eggs.

3. Pathogenic effect of eggs: Aphid eggs left in various intestinal tissues such as liver, bile duct, pancreas and mesentery, can cause local inflammatory lesions, eosinophilic abscess, and then form aphid granuloma . Granuloma is composed of eosinophils, giant cells, fibroblasts, fibroblasts, and proliferating connective tissue surrounded by fibers. The pathological type can be divided into foreign body giant cell granuloma and pseudotuberculous granuloma, and pseudotuberculous granuloma is more common. Aphid eggs left in the gallbladder and bile duct can also become the core of biliary stones.

an examination

Related inspection

Conventional abdominal plain film gastrointestinal imaging

Eye white blue gray or black spot check

1. Clinical diagnosis basis

(1) Adult parasites can be diagnosed according to the recent history of worms or vomiting.

(2) Children repeatedly have abdominal or umbilical pain on Monday, or with partial eclipse, night molars, abdominal distension, etc. can prompt mites infection. If there is comorbidity, it should be judged according to the corresponding symptoms, signs and relevant examination results; if there is biliary colic, cholangitis, pancreatitis should consider the possibility of complications of intestinal ascariasis; abdominal pain, vomiting, bloating in children Attention should be paid to the possibility of aphid-induced intestinal obstruction when stopping the discharge of stool and venting, and sputum and abdominal cord-like masses.

(3) In the rural harvest season, after sudden fever, cough, and asthma in the collective population, other causes may be excluded, and the possibility of pneumonia caused by acute aphid larvae may be considered in combination with medical history and physical signs.

(4) If there is only male parasite in the intestine and the feline is negative in the feces (3% to 5% of the infected person), the deworming drug can be used for diagnostic treatment.

2. Laboratory and auxiliary examination of fecal smear to check eggs is the simplest, quick and reliable basis for the diagnosis of intestinal ascariasis. Discretionary selection of the following tests is helpful for diagnosis. For example, gastrointestinal swallowing can show the shape and quantity of aphids; abdominal X-ray film is of great value in the diagnosis of aphid intestinal obstruction or intestinal perforation peritonitis; duodenal drainage Seeing eggs is a direct evidence of biliary ascariasis.

Differential diagnosis

Eye white blue gray or black spots confusing symptoms

1. Defects appear on the conjunctiva of the eye: The presence of imperfections on the conjunctiva is one of the clinical manifestations of sepsis. The clinical onset of sepsis is acute, and the rash is in various forms such as sputum, urticaria, pustular rash and scarlet fever-like rash, and defects appear on the conjunctiva.

2, the point on the cornea dark gray turbidity: due to corneal opacity disease, with a point on the cornea with dark gray turbidity. The cornea is a transparent tissue with avascular structure. Transparency is the greatest feature of corneal tissue and is an essential element of its physiological function. Once it is affected by trauma or harmful factors, its transparency is lost and turbidity can cause visual impairment.

3, sputum conjunctiva tear area gray gray mass: sputum conjunctiva tear area gray gray tumor is one of the clinical manifestations of palpebral conjunctival melanoma. Melanoma is a malignant tumor of melanocytes derived from the skin, mucous membranes, and pigmented areas of the central nervous system.

Diagnosis based on clinical symptoms, laboratory tests and auxiliary examinations.

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