Schistosomiasis

Introduction
This is a slow, progressive disease caused by

blood flukes of the class Trematoda. It is a

chronic wasting disease common among
farmers and their families in certain parts of
the world.

Affects many in developing countries (its

estimated that 207M have the disease and that of

those, 120M are symptomatic).

 ETILOGIC AGENTS:
1. Schistosoma japonicum
This agent infects the intestinal tract (Katayama
disease)
Found to be the only type that is endemic in the
Philippines
Oriental Schistosomiasis

 S. japonicum eggs small and almost

spherical with tiny spine

 2. Schistosoma mansoni
It also affects the intestinal tract
Most common in parts of Africa.
S. mansoni eggs have a spike on the side
(spine).

3. Schistosoma haematobium
-Affects the urinary tract.
-Can be found in some parts of the Middle East,
like Iraq and Iran.
-S. haematobium eggs are oval and have a spike
at the tip

Incubation period
Incubation period is at least 2 months.

Source of Infection:
1. Feces of infected person
2. Dogs, pigs, carabaos, cows, monkeys and
wild rats have been found to be infected and
therefore, also serve as hosts.

Mode of transmission
The disease is transmitted through:

1. ingestion of contaminated water.

2. Penetration through skin pores.
3. Intermediate host- Tiny snail called the
Oncomelania quadrasi

Characteristics of Oncomelania
quadrasi

The snail thrives best along riverbanks, fresh

water streams, creeks, canals and swamps.

It can be found clinging to water hyacinths,
grasses, decaying leaves and pieces of rotting
wood, bamboo and coconut husks
The adult snail is greenish-brown in color
and is just as big as the smallest grain of a
palay.

PATHOGENESIS
The larvae (cercariae) penetrates the skin or

mucuous membranes and eventually work

their way to the livers venous portal
circulation.
In the portal vessels, they mature within 1 to 3
months.
The mature worms live in the copula in the
portal vessels and migrate to the other parts of
the body.

 The female cercaria lays eggs in the blood

vessels surrounding the large intestines or

bladder.
Ulceration in the mucosa occurs and the

eggs are able to escape into the lumen of the

large intestine and are excreted with feces.
Some of the eggs are carried by the portal

circulation and filtered in the liver where

small lesions or granulomas are formed.

 These granulomas are resolved and are

replaced by fibrous tissue.

Likewise, the ulcerations in the intestines

are healed and scar formation occurs.

As the disease progresses, the liver enlarges

due to increasing fibrosis.

 The flow of blood is interrupted in the

intrahepatic portion, thereby resulting in

portal hypertension.
Fluid accumulates in the patients bely,

making it bulge (Ascites).

Pathology

Colon: acute -mucosa congestion,

edema and egg granuloma

chronic-fibro obstructive lesion
Liver: acute -enlargement of the liver
and egg granuloma on it
chronic-portal liver cirrhosis .

Clinical
Manifestations

 The signs and symptoms of the disease will

depend on the site of infection however the

following can be observed:

1. A pruritic rash known as the swimmers

itch develops at the site of penetration.

 2. Low grade fever, myalgia and cough.

3. There is abdominal discomfort due to

hepatomegaly, splenomegaly and

lymphadenopathy.
4. There are bloody-mucoid stools, similar to

those in dysentery, that comes on and off for

weeks.

 5. Patient becomes icteric and jaundiced.

6.Later, the patients belly becomes big

because of an inflamed liver, resulting from

the accumulation of eggs in the organ.
7.Patient becomes weak, pale and there is

marked muscle wasting.

8. When the parasites reach the brain, there

will be severe headache, dizziness and

convulsions

Acute Schistosomiasis
Clinical manifestations come out after 4 to 8

weeks of infection, similar to the time from egg

to adult worm (40 days)
Fever: intermittent, maintain weeks to months
Allergic reaction:urticaria, angioneuroedema,
enlargement of lymph nodes and eosinophilia
Digestive syndromes: abdominal pain, diarrhea
with pus and blood, constipation or diarrhea
Hepatosplenomegaly

Chronic Schistosomiasis
Asymptomatic: most person are

asymptomatic
Symptomatic: the most common syndrome
is abdominal pain with intermittent diarrhea.
hepatosplenomegaly

COMPLICATIONS
1. Liver Cirrhosis & Portal HPN
2. Cor pulmonale & Pulmonary HPN
3. Heart failure
4.Ascites
5.Hematemesis- from REV
6. Renal failure
7. Cerebral schistosomiasis

 Cerebral schistosomiasis is caused by the

hosts reaction to schistosoma eggs, The

mechanism of egg deposition is unknown,
but the presnce of the eggs suggests that
they may cross the BBB or that some worm
pairs may reach the venous side of the
cerebral circulation.

Diagnostics
1. Fecalysis or Direct stool exam
2. Kato-Katz technique
3. Liver and rectal biopsy
4. ELISA
5. Circumoval precepitin test (COPT)

Treatment

Treatment
Praziquantel is the best choice of drug for the

therapy of schistosomiasis
Dose:
1 tab 2x a day for three months then 1 tab a
day for another 3 months.
Fuadin injection given either IM or IV. The
patient should consume 360mg for the entire
treatment.

Prevention
To prevent schistosomiasis, one must have

through knowledge of how the disease

spreads. The basic principle of its
prevention and control is interrupting the
life cycle of the worm and protecting people
from the infection. This can be achieved
through the following measures:

 1. Have a stool examination.

2. Reduce snail density by:
A. clearing vegetation, thus exposing the snails
to sunshine.
B. constructing a drainage system (canals) to
dry the areas where the snails thrive.
C. Improve farming through the proper
irrigation and drainage, crop rotation and
removal of weeds thus disturbing the living
condition of the snail.

 3. Diminish infection rate through:

A. Proper waste disposal
B. Control of stray animals
C. Prohibition of people especialy children
from bathing in infested streams.
D. Construction of footbridges over small
infested streams
E. provision of an adequate water supply for
bathing and laundering and safe water for
drinking.
4. Providing health education on the disease
process, mode of transmission and prevention.

Common Nursing Diagnosis

Risk for Infection and Bleeding
Impaired skin integrity
Altered urinary elimination
Body image disturbance
Altered role function
Knowledge deficit