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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,
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
excreta
The presence of the snail
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,
Chronic Schistosomiasis
Asymptomatic: most person are
asymptomatic
Symptomatic: the most common syndrome is
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
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
rise
Terminal stage: WBC and platelets are lower
rise
Chronic stage: most patients have a normal
liver cirrhosis
Stool Test
The discovery of eggs in stool is the evidence of
Imaging test
B-ultrasound: the degree of liver cirrhosis CT: the image of liver and brain X-ray: chest; esophagus; and gastrointestinal tract
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
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