SCHISTOSOMIA
SIS
OUTLINE
• DEFINITION
• EPIDEMIOLOGY
• ETIOLOGY
• MODE OF TRANSMISSION
• PATHOGENESIS
• CLINICAL PICTURE
• DIAGNOSIS
• DIFFERENTIALS
• TREATMENT
• COMPLICATION
• PROGNOSIS
DEFINITION
• Schistosomiasis (Snail fever) is a parasitic disease caused
by flatworm called Schistosome.
• Schistosomes are known as blood flukes as they live in
vascular system of humans and other vertebrate hosts.
EPIDEMIOLOGY
• The disease is found in Africa, South America, East Asia
and Middle East.
• Over 230 million people require treatment yearly for
Schistosomiasis.
• 90% of those requiring treatment live in Africa.
• More than 200,000 death per year are due to
Schistosomiasis Sub-Saharan Africa.
ETIOLOGY
• Parasitic worms of Schistosoma species.
• Main species include
i. Schistosoma Haematobium- reside in venous plexus of urinary bladder.
ii. Schistosoma Mansoni- reside in mesenteric veins draining sigmoid rectal
region
iii. Schistosoma Japonicum- reside in the mesenteric veins draining the
ileocecal region
iv. Schistosoma Mekongi- reside in mesenteric veins draining colon
v. Schistosoma Intercalatum- reside in mesenteric veins draining rectum
Life Cycle
Life Cycle
• Parasite are released (by urination or defecation) into environment from
infected individual
• The eggs hatches on contact with fresh water to release the free
swimming miracidium
• Miracidium then penetrate water snail tissue where it develops into
cercaria.
• Cercaria is released into water from the snail and they're in infective
stage.
• When a person enters into the infested water, the cercaria penetrate to
the skin of human, circulate to organs (GIT, Urinary Tract)
Pathogenesis
• People become infected when the larval forms of the parasite-
released by fresh water snails penetrate their skin during contact
with infested water
• The larvae then develops into adult schistosomes.
• Adult schistosomes live in blood vessel where female release eggs.
• Some of these eggs are passed out of the body in the feaces or urine
to continue their life cycle.
• Others become trapped in body tissue(intestinal and urinary system)
causing an immune reaction and progressive damage to organs.
Schistosoma mansoni
S. mansoni produces intestinal schistosomiasis in humans.
first identified by Sir Patrick Manson in West Indies. The
pathogenesis of schistosomiasis mansoni occurs in three
stages
• 1).Cercarial Dermatitis
• After 2 or 3 days of skin perpetration of cercaria larvae, an
itchy maculopapular rash develops on the affected areas of
the skin called as cercarial dermatitis (swimmer’s itch).
This is also observed in S. japonicum infection.
2. Acute Schistosomiasis (Katayama
Syndrome)
• It occurs within 4–8 weeks of infection, especially when the
schistosomes start producing eggs. It is less common in endemic area.
• The antigens (released from the eggs) and the adult worms stimulate
the host humoral response, leading to the formation of immune
complexes and serum sickness like illness called Katayama fever.
• It is characterized by fever, generalized lymphadenopathy, and
hepatosplenomegaly.
• Parasite-specific antibodies may be detected. There is a high peripheral
blood eosinophilia.
3. Chronic Schistosomiasis
• After eggs are produced, they are trapped in the small venules and are carried from
intestine through portal circulation into liver and other parts of the body. Common
form of chronic schistosomiasis include;
i. Intestinal disease: Fibrosis and thickening occurs in the intestinal wall along the
entire length of colon and rectum. Patient may present with diarrhea or dysentery
ii. Hepatosplenic disease: Granuloma formation and fibrosis in liver (called as
Symmers pipestem fibrosis) impedes the portal blood flow leading to portal
hypertension, hepatomegaly, splenomegaly and gastric varices
[Link] involvement leads to pulmonary hypertension and right sided heart
failure
iv. Neuroschistosomiasis involving brain and spinal cord
v. Kidney: Nephrosclerosis and kidney failure may occur due to circulating immune
complexes deposited in glomerular membrane
vi. Secondary bacterial infection can occur, especially with Salmonella species and
Staphylococcus aureus. S. aureus colonizing in liver can cause liver abscess.
Clinical picture- low grade fever, fatigue,
weight loss and anemia
Intestinal Urogenital
schistosomiasis schistosomiasis
• Abdominal pain • Hematuria
• Diarrhea • Dysuria
• Hematochezia or Melena • Polykauria
• In female; genital lesion,
• Hematemesis vaginal bleeding, dyspareunia,
• Liver enlargement irregular menstruation.
Differential diagnosis
Intestinal Urogenital
schistosomiasis schistosomiasis
• Peptic ulcer disease • Renal Tuberculosis
• Pancreatitis • Urogenital tract cancer
• Cutaneous leishmaniasis • Urolithiasis.
Laboratory Diagnosis
a) Stool examination for S. mansoni and ova
b) Urinalysis and urine for S. haematobium and ova
c) General blood analysis: to check for anemia or eosinophilia
d) Serological: ELISA is available to detect circulating cathodic (CCA) and
circulating anodic antigens (CAA) of schistosomes in the serum and urine.
Dipstick test is available for detecting CCA in urine
e) BUN and creatinine level- to asses kidney function
f) Uretero-cystoscopy
g) Biopsy of rectum or urinary bladder- to detect schistoma egg in tissue sample
h) Plain abdominal X-ray: chronic cases may show calcification and fibrosis of
ureters, urinary bladder due to long standing of S, haematobium
i) Intravenous urography: may show the level of ureter stricture
j) Ultrasound of abdomen: hepatosplenomegaly, bilharzial hepatic fibrosis,
ascites
Treatment
Praziquantel is the drug of choice
For S. Haematobium and S. Mansoni
Start 20 mg/kg B.D
For S. Japonicum
Start 20 mg/kg TDS
Patient should be monitored for any seizure, or other neurological
effect
Corticosteroid is also added for reducing inflammation
Complication
Intestinal Urogenital
schistosomiasis schistosomiasis
• Liver fibrosis • Cystitis
• Intestinal cancer • Urinary bladder cancer
• Portal HTN/ pulmonary HTN or • Polyps/ ulcer of urinary bladder
Cor pulmonale • Hemospermia
• Ascites • Infertility
• Esophageal varices • Spontaneous abortion
• Malnutrition • Renal failure
• anemia
Prevention
• Education
• Eliminating the water-borne snails which are natural reservoirs for the
disease
• Annual dose of praziquantel adding niclosamide, acrolein, copper sulfate,
etc., to the water sources in order to kill the snails.
• Avoid swimming and contact with fresh water in endemic areas
• Boiling water for 1 minute will kill the parasite. (Filtration of drinking water)
Prognosis
• Its always good especially with prompt diagnosis and treatment.
