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SCHISTOSOMIASIS

Introduction
Schistosomiasis is a clinical term applied to infection with one of a series of related trematode parasites that are endemic to at least 76 tropical and sub-tropical countries.

This disease is most commonly found in Asia, Africa, and South America, especially in areas where the water contains numerous freshwater snails, which may carry the parasite.

Introduction
Schistosomiasis (also known as bilharzia,

bilharziosis or snail fever) is a parasitic disease


caused by several species of trematodes.

Schistosomiasis was discovered by Theodore

Bilharz, a German surgeon working in Cairo, who first identified the etiological agent Schistosoma hematobium in 1851.

Causative agents
Species of Schistosoma that can infect humans: Schistosoma mansoni and Schistosoma

intercalatum cause intestinal schistosomiasis Schistosoma haematobium causes urinary schistosomiasis Schistosoma japonicum and Schistosoma mekongi cause Asian intestinal schistosomiasis

Snail hosts

The different species of Schistosoma have different types of snails serving as their intermediate hosts; these hosts are as

follows.. Biomphalaria for S mansoni Oncomelania for S japonicum Tricula (Neotricula aperta) for S mekongi Bulinus for S haematobium and S intercalatum

Incubation Period
2 months

Etiology
Mature worms: Dioecious
Female :long and thin. Male:short and thick

Eggs: miracidia in it

Life cycle
adult worm passing eggs egg into fresh water

cercariae
miracidia penetrate into the body of the snail (intermediate host) oncomelania

Epidemiology
Source of infection: humans and mammals

(especially cattle) infected by schistosome


Route of transmission: three major factors*

are responsible for the occurrence of schistosomiasis


Susceptibility : everyone is susceptive.

Especially farmers and fisherman

Three Major Factors


The method of disposal of human

excreta
The presence of the snail

intermediate host (Oncomelania Quadrasi)


The contact with cercaria-infected

water

Pathogenesis
It belong to a kind of allergic reaction(rapid

& delayed)
Formation of granuloma produced by eggs

(Hoeplli sign)
Concomitant immunity

CLINICAL MANIFESTATIONS

Swimmers itch Low grade fever, myalgia and cough Hepatomegaly and spleenomegaly

Blody mucoid stools, dysentery like that comes on and off for 2 weeks
Jaundice

Abdominal enlargement

Acute Schistosomiasis
Mainly occurs during July to September
The history of contact with schistosome-

infected water. Schistosome dermatitis Incubation period: 23-73 days, average 1 month

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

Terminal stage of schistosomiasis


Liver cirrhosis is the prominent syndrome of

this stage
According to the manifestations , it can be

divided into three types: The type of giant spleen The type of ascites The type of dwarf

Pathopyhsiology
egg are elminated with feces and urine
Egg hatch release miracidia swim/penetrates snail

Sporocysts and production of cercariae


Snail inefective cercariae swim penetrate to human host shed their forked tail-schistosomulae Migrates to several tissue and stages to their residence in vein

Adult worms resides in the mesenteric The female deposits eggs in the small venules of the portal and perivesical system The eggs are move progressively toward the lumen of intestine, bladder or ureter and are eliminated

LABORATORY FINDINGS

Blood Routine Test


Acute stage :eosinophilia is characteristic

change.WBC raise to 10-30G/L


Chronic stage:eosinophil slightly or moderate

rise
Terminal stage: WBC and platelets are lower

Liver Function Test


Acute stage: serum globulin rise, ALT slightly

rise
Chronic stage: most patients have a normal

liver function, especially asymptomatic


Terminal stage: serum ALB descend caused by

liver cirrhosis

Stool Test
The discovery of eggs in stool is the evidence of

diagnosis by direct smear or other methods

Imaging test
B-ultrasound: the degree of liver cirrhosis CT: the image of liver and brain X-ray: chest; esophagus; and gastrointestinal tract

Biopsy by Rectal Endoscope

Immunological Test
Intracutaneous test
Circumoval precipition test ELISA and IHA etc. Monoclonal antibody technique

Treatment
Pathogenic Treatment Praziquantel is the best choice of drug for the therapy of schistosomiasis Dose: chronic schistosomiasis 10mg/kg, tid. Po, for 2 days, total 60mg/kg Acute schistosomiasis 10mg/kg,tid. po,for 4 days, total 120mg/kg Vice reaction: slight and short.

Treatment
Heteropathy
Acute schistosomiasis: rest, nutrition, and

supportive theraphy. Cortical hormone can be


used in minidose for severe toxic symptoms.
Terminal schistosomiasis: treated as liver

cirrhosis, and treat for complications

Prevention
Control of the source of infection:

Treat the patients and domestic animal at the same time. Cut off the route of transmission: Snail control Sanitary disposal of human excreta Protect of susceptive people:avoid the contact with schistosome-infected water