Schistosomia

sis
Schistosomiasis (also known
as bilharzia, bilharziosis or snail
fever) is a parasitic disease caused
by several species
of trematodes (platyhelminth infecti
on, or "flukes"), a parasitic worm of
the genus Schistosoma
Endemic in 10 regions in the
hilippines, !" provinces, 1#$
municipalities 1,!1! barangays,
%igh prevalence in &egion ' ((icol),
&egion # (Samar ) *eyte), &egion
11 (+avao)
,t is a chronic wasting disease
common among farmers and their
families in certain parts of the
hilippines-
.his is not only a public health
concern but also a socio/economic
problem because by causing ill/
health, it reduces agricultural
productivity (+0%, 11##)-

Incubation Period
.he incubation period is at least !
months-
Infectious agent:
/ S. mansoni affects intestinal
tract, found in 2frica
/ S. haematobium affects
urinary tract, found in the 3-E-
/ S. japonicum endemic in the
hilippines
infects the
intestinal tract
/ a-k-a- 4Oriental
Schistosomiasis5
Sources of Infection
6eces of infected persons
+ogs, pigs, carabaos, cows,
monkeys, and wild rats have been
found to be infected and therefore,
they also serve as host
Mode of Transmission
.he disease is transmitted
through ingestion of
contaminated water-
.he disease is transmitted
through the skin pores-
.he disease is transmitted
through an intermediary host, a
tiny snail called Oncomelania
Quadrasi-
Mode of Transmission
Skin comes in contact with or ingestion of
contaminated fresh water

*arva forms that penetrate the skin

6resh water were infected when infected

people urinate or defecate in the water

Eggs hatch, enters the snail grow )

develop

arasite leaves the snail goes to the water

where they can
survive for "# hrs-

w7n several weeks parasites grow inside

blood vessels ) produce eggs
Risk Factors
&isk factors for Schistosomiasis
are factors that do not seem to be
a direct cause of the disease, but
seem to be associated in some
way-
8ater snails
+rinking contaminated water
(athing in contaminated water
Swimming in contaminated water
9rine
6eces
Sewage
3iddle East
2frica
2sia
:entral 2merica
South 2merica
Signs & Symtoms
+iarrhea
2bdominal discomfort due to
enlargement, spleenomegaly,
lymphadenopathy
2nemia
,nflamed liver ; later stage
(accumulation of eggs)
ruritic rash at site of penetration
; 4swimmers itch5
*ow grade fever, myalgia, cough
(loody mucoid stool ; on and off
for weeks
atient becomes pale, weak,
marked muscle wasting
Severe %2, di<<iness, convulsion
when parasites reach the :=S
,cteric and >aundice
!omlications
*iver cirrhosis (portal %=)
:or pulmonale (pulmonary %=)
%eart failure
2scitis
%ematemesis (rupture of
eosophageal varices)
&enal failure
"iagnosis Procedures
6ecalysis or direct stool e?am
@ato @at< techniAue
/ a laboratory method for
preparing human stool samples
prior to searching for parasite
eggs-
*iver and rectal biopsy
En<yme *ink ,mmunusorbent
2ssay (E*,S2)
/ a test that uses antibodies
and color change to identify a
substance-
:ercum 0va recipitin .est
(:0.) / confirmatory diagnostic
test
Treatment
ra<iAuantel B "0 / C0 mg7kg
3ode of action B calcium
permeation
0ther drugsB o?amniAuine and
metrifonate (8%0)
,f the infection is severe or
involves the brain, corticosteroids
may be given-
6reAuency B
once a year in high risks
communities
once every ! years in
moderate/risk communities
twice during period of primary
schooling
Methods of !ontrol
A/ Preventive measures:
educate the public in endemic areas
reB 3-0-.-
dispose of feces ) urine so that
viable eggs will not reach body of
fresh water containing snail host
improve irrigation ) agricultural
practicesB snail habitats by
draining ) removing vegetation
.reat snail/breeding sites w7
molluscicides
9se rubber boots
.owel dry the skin vigorously and
completely
2pply D0E alcohol immediately to
the skin
9se paper filters, get water from
sources free of cercariae or
treatment to kill them
.reat water with chlorine or iodine
2llowing water to stand "#/D! hrs
before use is also effective
B/ Control of Patients
/ report to local health authority
/ isolationB none
/ concurrent disinfectionB sanitary
disposal of feces and urine
/ AuarantineB none
/ immuni<ation of contactsB none

C/ Investigation of contacts & source
of infection
/ the search for the source is a
community effort
/ specific t?B ra<iAuantel ((iltricide) ;
drug of choice against all species
/ pay attention to infected children
/ motivate people in these areas to
have annual stool e?amination
/ %= in endemic areas participates
actively
#ursing "iagnosis and
Interventions
$%& "ehydration
rovide e?tra fluid with
meals, including >uice, soup,
ice cream and sherbet,
gelatin, water on trays-
0ffer opsicles between
meals-
2ssess vital signs, noting
peripheral pulses-
3onitor blood pressure and
invasive hemodynamic
parameters-
Strictly monitor intake and
output- 0bserve the physical
properties of the urine-
:orrectly infuse the right
amount of ,F6-
Encourage small, freAuent
feedings-
rovide freAuent, oral care-
2dminister medications as
prescribe
'%& (bdominal ain
3aintain bed rest in a
comfortable position, do not
support the knee-
2ssess the location, weight
and type of pain
2ssess effectiveness and
monitor side effects of
analgesicG avoid morphine
rovide a planned rest period-
:hange positions freAuently
and give her back rubbing
and skin care-
2uscultation bowel soundsG
kekauan or notice increasing
painG give enema slowly when
ordered-
Hive and recommend
alternative pain relief
measures-
Hive ,F 6luids as order
+ecreased an?iety with
increased knowledge of
disease,
3onitor clientIs laboratory
tests results for abnormal
values-
rovide emotional support to
client
)%& (ctivity intolerance
related to *eakness
Hive ,F 6luids as order
+ecreased an?iety with
increased knowledge of
disease,
3onitor clientIs laboratory
tests results for abnormal
values-
rovide emotional support
to client
+etermine patientJs
perception of causes of
fatigue or activity
intolerance- .hese may be
temporary or permanent,
physical or psychological-
3onitor patientJs sleep
pattern and amount of
sleep achieved over past
few days- +ifficulties
sleeping need to be
addressed before activity
progression can be
achieved-