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Schistosomiasis

Bilharzia


Presentation

Systemic

The patient may initially complain of abdominal pain, diarrhea or dysentery and fever. Blood tests may reveal eosinophilia. He may also complain of fatigue, lethargy and skin sores and itching.

CNS

Neurological involvement may present with headaches, nausea, paresthesia, seizures, signs of muscle weakness and paraplegia.

Genitourinary

If the genital involvement is present, genital sores and ulceration may occur. Females may suffer with post coital bleeding and irregular menstruation. If the infection has spread to the bladder or urinary tract, cystitis, urethritis and glomerulonephritis may be present. In these cases, the patient may complain of pelvic pain, hematuria, dysuria, urinary frequency, etc.

Splenomegaly
  • Initial investigation showed signs of liver fibrosis, portal hypertension and splenomegaly.[ncbi.nlm.nih.gov]
  • The hepatosplenic form of the disease is characterized by periportal hepatic fibrosis, pre-sinusoidal portal hypertension and splenomegaly. Liver function is preserved, being varices bleeding the main complication of the disease.[ncbi.nlm.nih.gov]
  • In China and Japan and in the Philippines there is a disease known as Asiatic schistosomiasis, which is characterized by cirrhosis of the liver, splenomegaly, ascites, dysentery, progressive anemia, and sometimes[jamanetwork.com]
  • Eosinophilia is present, as well as often painful hepatomegaly or splenomegaly. The clinical manifestations of chronic schistosomiasis are the result of host immune responses to schistosome eggs.[web.archive.org]
  • Eosinophilia is often present, as well as painful hepatomegaly or splenomegaly. The clinical manifestations of chronic schistosomiasis are the result of host immune responses to schistosome eggs.[wwwnc.cdc.gov]
Fever
  • Signs and symptoms include fever, abdominal pain, eosinophilia and hepatosplenomegaly. If left untreated it may eventually cause liver damage leading to cirrhosis, bladder cancer and kidney failure.[icd9data.com]
  • The specific diagnosis of early schistosomiasis and Katayama fever relies essentially on serologic tests or preferably on PCR (if available).[ncbi.nlm.nih.gov]
  • Bilharzia; Katayama fever; Swimmer's itch; Blood fluke; Snail fever Bustinduy AL, King CH. Schistosomiasis. In: Farrar J, Hotez PJ, Junghanss T, Kang G, Lalloo D, White NJ, eds. Manson's Tropical Diseases . 23rd ed.[nlm.nih.gov]
  • It is also called Bilharzia, Katamaya Syndrome and Snail Fever.[symptoma.com]
Anemia
  • Children with long-term or repeat infections can suffer from anemia and malnutrition, which can contribute to lost days at school and serious learning disabilities.[cdc.gov]
  • The most common symptoms are blood in urine and/or feces and an enlarged liver, diarrhea, abdominal pain, weakness, and anemia.[cartercenter.org]
  • Depending on where the eggs lodge, manifestations of chronic schistosomiasis can include diarrhea, abdominal pain, loss of appetite, anemia (intestines), hepatosplenism, periportal fibrosis with portal hypertension (liver), urogenital inflammation and[orpha.net]
  • Children who are repeatedly infected can develop anemia, malnutrition, and learning difficulties. After years of infection, the parasite can also damage the liver, intestine, spleen, lungs, and bladder.[cdc.gov]
Chills
  • Parasitic disease of tropical and subtropical countries; characterized initially by fever, chills, and abdominal and lower back pain; untreated patients may develop jaundice, liver cirrhosis, bladder tumors, and kidney failure.[icd9data.com]
  • Within 1-2 months of infection, symptoms may develop including fever, chills, cough, and muscle aches. Chronic schistosomiasis Without treatment, schistosomiasis can persist for years.[cdc.gov]
  • Many parasites may cause fever, chills, swollen lymph nodes, and swollen liver and spleen. When the worm first gets into the skin, it may cause itching and a rash (swimmer's itch). In this condition, the schistosome is destroyed within the skin.[nlm.nih.gov]
Fatigue
  • We report a woman presenting with cough, fatigue, atypical optic neuritis with chiasmitis. She responded partially to corticosteroids and we subsequently found she had a ground-glass lung nodule.[ncbi.nlm.nih.gov]
  • […] or bilharzia, is a common intravascular infection caused by parasitic Schistosoma trematode worms It is prevalent in Africa, the Middle East, South America, and Asia Acute schistosomiasis, or Katayama syndrome, can present as fever, malaise, myalgia, fatigue[doi.org]
  • , Hospital Universitario Vall d’Hebron, Barcelona, Spain b Servicio de Neumología Pediátrica, Hospital Universitario Vall d’Hebron, Barcelona, Spain Article An 11-year-old black girl from Equatorial Guinea was admitted to our hospital to investigate fatigue[revespcardiol.org]
  • He may also complain of fatigue, lethargy and skin sores and itching. CNS Neurological involvement may present with headaches, nausea, paresthesia, seizures, signs of muscle weakness and paraplegia.[symptoma.com]
Malaise
  • Schistosomiasis, or bilharzia, is a common intravascular infection caused by parasitic Schistosoma trematode worms It is prevalent in Africa, the Middle East, South America, and Asia Acute schistosomiasis, or Katayama syndrome, can present as fever, malaise[doi.org]
  • The intestinal worms produce a wide range of symptoms including diarrhoea and abdominal pain, general malaise, and weakness. Hookworms cause chronic intestinal blood loss that can result in anaemia.[ntd-ngonetwork.org]
  • Four to 8 weeks after exposure, an acute illness can develop, manifested by fever, malaise, cough, rash, abdominal pain, diarrhea, nausea, lymphadenopathy, and eosinophilia (Katayama fever).[meddean.luc.edu]
  • Symptoms may also include malaise, arthralgia or myalgia cough, diarrhoea and right upper quadrant pain. Signs Fever. Hepatosplenomegaly, right upper quadrant pain or tenderness. Urticaria may be seen occasionally, lymphadenopathy.[patient.co.uk]
Cough
  • , wheezing, shortness of breath and coughing up blood nervous system or brain can cause seizures (fits), headaches , weakness and numbness in your legs, and dizziness Without treatment, affected organs can become permanently damaged.[nhs.uk]
  • Pertussis, also known as whooping cough, is a highly contagious respiratory disease. It is caused by the bacterium Bordetella pertussis . Pertussis is known for uncontrollable, violent coughing that often makes it hard to breathe.[niaid.nih.gov]
  • We report a woman presenting with cough, fatigue, atypical optic neuritis with chiasmitis. She responded partially to corticosteroids and we subsequently found she had a ground-glass lung nodule.[ncbi.nlm.nih.gov]
  • Within 1-2 months of infection, symptoms may develop including fever, chills, cough, and muscle aches. Chronic schistosomiasis Without treatment, schistosomiasis can persist for years.[cdc.gov]
Dry Cough
  • It is seen, however, in native residents of China infected with S. japonicum. [20] Symptoms include: Dry cough with changes on chest X-ray Fever Fatigue Muscle aches Malaise Abdominal pain Enlargement of both the liver and the spleen The symptoms usually[en.wikipedia.org]
Abdominal Pain
  • FINDINGS: Less than half of the 65 care providers mentioned one or more major symptoms of intestinal schistosomiasis (abdominal pain 43.1%, bloody diarrhoea 13.9% and bloody stool 7.7%).[ncbi.nlm.nih.gov]
  • A case of a 25-year-old woman with 8 weeks amenorrhoea, lower abdominal pain and per vaginal bleeding was managed for ruptured ectopic pregnancy and discovered to have tubal infection by Schistosoma on histological examination is presented.[ncbi.nlm.nih.gov]
  • Depending on where the eggs lodge, manifestations of chronic schistosomiasis can include diarrhea, abdominal pain, loss of appetite, anemia (intestines), hepatosplenism, periportal fibrosis with portal hypertension (liver), urogenital inflammation and[orpha.net]
  • Signs and symptoms include fever, abdominal pain, eosinophilia and hepatosplenomegaly. If left untreated it may eventually cause liver damage leading to cirrhosis, bladder cancer and kidney failure.[icd9data.com]
  • A 20-year-old male patient with a past medical history of appendectomy and ileocecal Crohn's disease, presented with abdominal pain and vomiting. Ileocolonoscopy showed an ulcerated and congested appearance of the upper rectum and sigmoid.[ncbi.nlm.nih.gov]
Diarrhea
  • […] noun another term for bilharzia (the disease) ‘Water-related diseases cause 80 percent of all the world's sicknesses, in the forms of hepatitis A, malaria, diarrhea, dysentery and schistosomiasis.’[oxforddictionaries.com]
  • Depending on where the eggs lodge, manifestations of chronic schistosomiasis can include diarrhea, abdominal pain, loss of appetite, anemia (intestines), hepatosplenism, periportal fibrosis with portal hypertension (liver), urogenital inflammation and[orpha.net]
  • RESULTS: Five of 50 (10%) patients were admitted to the hospital: 1 with myeloradiculopathy, 1 with diffuse pulmonary micronodules, and 3 with diarrhea and dehydration. All 5 had hypereosinophilia and prolonged fever.[ncbi.nlm.nih.gov]
  • The most common symptoms are blood in urine and/or feces and an enlarged liver, diarrhea, abdominal pain, weakness, and anemia.[cartercenter.org]
Nausea
  • CNS Neurological involvement may present with headaches, nausea, paresthesia, seizures, signs of muscle weakness and paraplegia. Genitourinary If the genital involvement is present, genital sores and ulceration may occur.[symptoma.com]
  • The infection may cause an itchy rash, then after several weeks, fever, chills, muscle aches, fatigue, nausea, abdominal pain, and, later, other symptoms depending on which organ is affected.[msdmanuals.com]
  • Four to 8 weeks after exposure, an acute illness can develop, manifested by fever, malaise, cough, rash, abdominal pain, diarrhea, nausea, lymphadenopathy, and eosinophilia (Katayama fever).[meddean.luc.edu]
  • Transient dizziness, nausea and vomiting were most commonly reported.[doi.org]
  • (M‐H, Fixed, 95% CI) 5.59 [0.28, 112.34] 4.11 Itching 1 156 Risk Ratio (M‐H, Fixed, 95% CI) 1.0 [0.19, 5.28] 4.12 Cough 1 156 Risk Ratio (M‐H, Fixed, 95% CI) 1.0 [0.09, 10.78] 4.13 Chills 1 156 Risk Ratio (M‐H, Fixed, 95% CI) 1.5 [0.16, 14.07] 4.14 Nausea[doi.org]
Hematemesis
  • Four males died of hematemesis secondary to portal fibrosis. The crude mortality rate of schistosomiasis was is 51/100,000/year.[ncbi.nlm.nih.gov]
Palpitations
  • Abdominal pain Abdominal swelling ( ascites ) Bloody diarrhea or blood in the stools Blood in the urine and painful urination Shortness of breath and coughing Weakness Chest pain and palpitations Seizures Paralysis Mental status changes Lesions on the[medicinenet.com]
Hepatosplenomegaly
  • Signs and symptoms include fever, abdominal pain, eosinophilia and hepatosplenomegaly. If left untreated it may eventually cause liver damage leading to cirrhosis, bladder cancer and kidney failure.[icd9data.com]
  • Clinical features of schistosomiasis range from fever, headache, and lethargy to severe fibro-obstructive pathology leading to portal hypertension, ascites, and hepatosplenomegaly, which can cause premature death.[web.archive.org]
  • Hepatosplenomegaly. Signs Abdominal tenderness. Ascites with portal hypertension. Seizures and/or altered mental state (with cerebral infection).[patient.co.uk]
Hepatomegaly
  • Physical examination is notable for hepatomegaly, most prominent in the left hepatic lobe. She also has an urticarial rash in her left foot.[medbullets.com]
  • Hospital Universitario Vall d’Hebron, Barcelona, Spain b Servicio de Neumología Pediátrica, Hospital Universitario Vall d’Hebron, Barcelona, Spain Article An 11-year-old black girl from Equatorial Guinea was admitted to our hospital to investigate fatigue, hepatomegaly[revespcardiol.org]
  • Eosinophilia is present, as well as often painful hepatomegaly or splenomegaly. The clinical manifestations of chronic schistosomiasis are the result of host immune responses to schistosome eggs.[web.archive.org]
  • Eosinophilia is often present, as well as painful hepatomegaly or splenomegaly. The clinical manifestations of chronic schistosomiasis are the result of host immune responses to schistosome eggs.[wwwnc.cdc.gov]
  • In acute infections with heavy infection due to Schistosoma mansoni or Schistosoma japonicum, a mucoid bloody diarrhea accompanied by tender hepatomegaly occurs.[meddean.luc.edu]
Myalgia
  • Schistosomiasis, or bilharzia, is a common intravascular infection caused by parasitic Schistosoma trematode worms It is prevalent in Africa, the Middle East, South America, and Asia Acute schistosomiasis, or Katayama syndrome, can present as fever, malaise, myalgia[doi.org]
  • […] cell bladder cancer ( S. haematobium ) portal hypertension ( S. mansoni and S. japonicum ) Prognosis treatment may decrease organ pathology Presentation Symptoms pruritus after swimming ("swimmer's itch") suggestive of larval penetration fever chills myalgias[medbullets.com]
  • Acute schistosomiasis is characterized by fever, headache, myalgia, diarrhea, and respiratory symptoms. Eosinophilia is present, as well as often painful hepatomegaly or splenomegaly.[web.archive.org]
  • Acute schistosomiasis is characterized by fever, headache, myalgia, diarrhea, and respiratory symptoms. Eosinophilia is often present, as well as painful hepatomegaly or splenomegaly.[wwwnc.cdc.gov]
Back Pain
  • Abstract A 77-year-old man with back pain and abdominal distention underwent F-NaF PET/CT examination to evaluate potential bone lesions.[ncbi.nlm.nih.gov]
  • Parasitic disease of tropical and subtropical countries; characterized initially by fever, chills, and abdominal and lower back pain; untreated patients may develop jaundice, liver cirrhosis, bladder tumors, and kidney failure.[icd9data.com]
  • Definition (CSP) parasitic disease of tropical and subtropical countries; characterized initially by fever, chills, and abdominal and lower back pain; untreated patients may develop jaundice, liver cirrhosis, bladder tumors, and kidney failure.[fpnotebook.com]
  • Although thoracic and back pain is often reported as an early symptom, it was not among the most frequently reported symptoms ( Table I ), affecting only 18 patients (66.7%).[doi.org]
Headache
  • CASE PRESENTATION: The reported case is of a 9-year old sukuma-black African boy referred to Bugando Medical Centre with complaints of fever, abdominal pain, headache and generalized body weakness.[ncbi.nlm.nih.gov]
  • Clinical features of schistosomiasis range from fever, headache, and lethargy to severe fibro-obstructive pathology leading to portal hypertension, ascites, and hepatosplenomegaly, which can cause premature death.[web.archive.org]
  • […] haematobium ) portal hypertension ( S. mansoni and S. japonicum ) Prognosis treatment may decrease organ pathology Presentation Symptoms pruritus after swimming ("swimmer's itch") suggestive of larval penetration fever chills myalgias and arthralgias headache[medbullets.com]
  • […] irritation of the bladder (cystitis) , pain when peeing, a frequent need to pee, and blood in your pee heart and lungs can cause a persistent cough, wheezing, shortness of breath and coughing up blood nervous system or brain can cause seizures (fits), headaches[nhs.uk]
  • CNS Neurological involvement may present with headaches, nausea, paresthesia, seizures, signs of muscle weakness and paraplegia. Genitourinary If the genital involvement is present, genital sores and ulceration may occur.[symptoma.com]
Dizziness
  • […] trials, high quality evidence).Splitting praziquantel 40 mg/kg into two doses over 12 hours probably has no benefits over a single dose, and in a single trial of 220 participants the split dose caused more vomiting (RR 0.5, 95% CI 0.29 to 0.86) and dizziness[ncbi.nlm.nih.gov]
  • […] peeing, a frequent need to pee, and blood in your pee heart and lungs can cause a persistent cough, wheezing, shortness of breath and coughing up blood nervous system or brain can cause seizures (fits), headaches , weakness and numbness in your legs, and dizziness[nhs.uk]
  • Transient dizziness was more commonly reported (lower dose first) Dizziness: 3% versus 8% Minor abdominal pain, headache and vomiting also reported.[doi.org]
  • Splitting praziquantel 40 mg/kg into two doses over 12 hours probably has no benefits over a single dose, and in a single trial of 220 participants the split dose caused more vomiting ( RR 0.5, 95% CI 0.29 to 0.86) and dizziness ( RR 0.39, 95% CI 0.16[cochrane.org]
Lethargy
  • Clinical features of schistosomiasis range from fever, headache, and lethargy to severe fibro-obstructive pathology leading to portal hypertension, ascites, and hepatosplenomegaly, which can cause premature death.[web.archive.org]
  • He may also complain of fatigue, lethargy and skin sores and itching. CNS Neurological involvement may present with headaches, nausea, paresthesia, seizures, signs of muscle weakness and paraplegia.[symptoma.com]
  • Symptoms include fever, lethargy, the eruption of pale temporary bumps associated with severe itching (urticarial) rash, liver and spleen enlargement, and bronchospasm.[en.wikipedia.org]
Paresthesia
  • CNS Neurological involvement may present with headaches, nausea, paresthesia, seizures, signs of muscle weakness and paraplegia. Genitourinary If the genital involvement is present, genital sores and ulceration may occur.[symptoma.com]
  • […] schistosomiasis is acute or subacute and presents with lumbar pain with or without radiation to lower limbs, evolving with diminishing of muscular strength in these limbs, with the possibility of presenting, in addition, sensory alterations such as hypoaesthesia, paresthesia[intechopen.com]
Focal Neurologic Deficit
  • Both intestinal and urogenital schistosomiasis can cause anemia and malnutrition [6] , and occasionally the eggs enter the central nervous system, causing symptoms such as seizures and focal neurological deficits [2] , [3] , [7] .[doi.org]
Hematuria
  • We report a case of a 37-year-old male who attended our hospital for terminal hematuria and irritative voiding symptoms. Schistosoma haematobium eggs were found in his urine sediment. He underwent transurethral resection of the bladder.[ncbi.nlm.nih.gov]
  • This case describes an 80 years old Egyptian male patient presented with recurrent hematuria and necroturia. Cystoscopy revealed a tumor involving the left lateral and the posterior wall of the urinary bladder.[ncbi.nlm.nih.gov]
  • […] where the eggs lodge, manifestations of chronic schistosomiasis can include diarrhea, abdominal pain, loss of appetite, anemia (intestines), hepatosplenism, periportal fibrosis with portal hypertension (liver), urogenital inflammation and scarring, hematuria[orpha.net]
  • The tests conducted included POC-CCA, double Kato-Katz slides, urine filtration and dipstick for hematuria. RESULTS: Of the 1954 participants that had complete data, the mean age of participants was 9.9 years.[ncbi.nlm.nih.gov]
  • DIFFERENTIAL DIAGNOSIS UROGENITAL SCHISTOSOMIASIS• Renal tuberculosis ("golf-hole" (gaping) ureteral orifice is seen during cystoscopy, Yellow raised nodules) surrounded by a halo of hyperemia in bladder)• Urogenital tract cancer ( total hematuria, hematuria[de.slideshare.net]
Dysuria
  • Here we report a 25 year old male who acquired the infection during travel to Malawi and presented with haematuria and dysuria. He was successfully treated with praziquantel.[ncbi.nlm.nih.gov]
  • […] eggs lodge, manifestations of chronic schistosomiasis can include diarrhea, abdominal pain, loss of appetite, anemia (intestines), hepatosplenism, periportal fibrosis with portal hypertension (liver), urogenital inflammation and scarring, hematuria and dysuria[orpha.net]
  • Symptoms attributable to infection such as haematuria, abdominal pain and dysuria were recorded in up to 90% of patients.[ncbi.nlm.nih.gov]
  • In these cases, the patient may complain of pelvic pain, hematuria, dysuria, urinary frequency, etc.[symptoma.com]
  • S. haematobium eggs typically lodge in the urinary tract and can cause dysuria and hematuria. Calcifications in the bladder may appear late in the disease.[web.archive.org]
Pelvic Pain
  • In these cases, the patient may complain of pelvic pain, hematuria, dysuria, urinary frequency, etc.[symptoma.com]
  • Most travellers in this time have no symptoms, but it can cause: blood in the urine or pain passing urine change in the bowel habit and/or blood in the bowel motions tummy/pelvic pain or genital lumps/bumps Years later, long standing disease can lead[fitfortravel.nhs.uk]
  • Symptoms and signs include dysuria, urgency, terminal microscopic and gross hematuria, secondary urinary tract infections, and nonspecific pelvic pain. Chronic urinary carriage and bacteremia with salmonella can occur.[meddean.luc.edu]
Frequency of Micturition
  • Haematuria, dysuria: The first feature may be frequency of micturition. Initially, haematuria is only terminal but, as it becomes more severe, the blood produces red urine throughout the stream. There is proteinuria.[patient.co.uk]
Macroscopic Hematuria
  • Symptoms were reported by 52.9% of the patients; abdominal pain (36%), macroscopic hematuria (11.3%), and genito-urinary symptoms (7.4%) being the most frequently reported.[ncbi.nlm.nih.gov]
  • hematuria in S. haematobium Screening following freshwater exposure in an endemic area may consist of a full blood count, absolute eosinophil count, Schistosoma serology, and urine and/ or fecal microscopy for eggs.[infectiousdiseaseadvisor.com]

Workup

Work up includes a physical exam and a detailed history, which my reveal any recent or old history of swimming, camping, travelling to any endemic area, etc.

Laboratory Tests

  • Complete blood count
  • PCR
  • Serology
  • Antigen tests: A reagent strip using monoclonal antibodies to detect somatic schistosome antigens in urine has a sensitivity of more than 85% and is suitable for use in the field [9]. 
  • Urine and stool analysis
  • LFTs
  • Kidney function tests

Imaging Studies

  • X-ray abdomen
  • Ultrasound
  • Urography
  • Intravenous pyelography
  • CT Scan
  • Endoscopy (for varices)

Test Results

Test results may confirm the presence of eggs or adult worms wherever present and also the degree of damage they have done.

Treatment

Once diagnosis has ben made and confirmed by appropriate tests, treatment is immediately begun. Praziquantel is the treatment of choice for all three species (of the worm) [3].

Praziquantel can be used in pregnant and lactating women [10]. In schistosomiasis with neurological involvement, glucocorticoids and anticonvulsants may be added if needed.

Prognosis

In cases of acute schistosomiasis if the patient is treated quickly with antihelminthics, prognosis is very good. All of the complications of the disease can be avoided. But, if the disease has progressed to chronic state, many systems may get involved and prognosis becomes less positive.

It should be noted that even in chronic state, however, with a continued treatment of 3-6 months to even years, many systemic manifestations of the disease may significantly improve. Renal and intestinal pathology also improves with treatment as, usually, do brain lesions (depending upon their location and size) [6].

Most of the mortality comes from hepatic cirrhosis, caused by S.mansoni in Latin America, Africa and the Middle East, and S.japonicum and S.mekongi in East Asia [7]

Complications

Complications of schistosomiasis are widespread. They can be divided systemically:

Gastrointestinal

Renal

Neurological

Urogenital

Systemic

Etiology

Schistosomiasis is an infection caused by Schistosoma species which are worms belonging to phylum Platyhelminthes. These trematodes are second only to malarial parasites as far as endemics are concerned.
                                                          
The life cycle of these worms involves an asexual cycle that occurs in freshwater snails, which serve as the intermediate host to the parasites. The sexual cycle occurs in humans, who serve as their definitive hosts.

The free-swimming young, known as the Cerceria (pl: cercariae), may enter the human host by penetration through the skin. Once they enter, they may move to the gut, vessels, liver, or anywhere else in the body, and the sexual cycle begins.

The cercariae then differentiate into the larva, enter the blood circulation, reach and settle into an organ and mature into adult forms. By now, symptoms may not appear.

The eggs laid by the schistosoma adult females penetrate through gut or bladder wall and colonise there. At this stage, symptoms usually appear.

When the eggs pass out through urine or stool and enter fresh water again, they may hatch, penetrate into the snails (intermediate host) and the asexual cycle begins again.

Types

There are five medically important species of Schistosoma. These are:

  • S.mansoni
  • S.japonicum
  • S.intercalatum
  • S.mekongi
  • S.haematobium

Schistosoma mansoni, Schistosoma japonicum and mekongi affect the gastrointestinal tract, whereas Schistosoma haematobium affects the urinary tract [3].

Epidemiology

Incidence

It affects almost 210 million people worldwide [1]. Around 200,000 people die of this disease every year.

Age

Studies reveal that although this disease may occur at any age, infants and children are at higher risk because of a less developed immune system. Congenital infection has been defined; Shistosomiasis has been detected in the placenta and newborns have been diagnosed with the disease, thus confirming congenital infection [2].

Sex

Mainly due to increased exposure to potential sources of the worm, males are at a greater risk of contracting this disease.

Sex distribution
Age distribution

Pathophysiology

Schistosomiasis develops when the the worms start to reproduce and multiply. Eggs penetrate the vascular endothelium and travel via the blood to various organs, most commonly affected are the gut, liver and urinary bladder.

Once settled, the parasites cause damage and widespread eosinophilia occurs. The damage is due both to digestion of tissue by proteolytic enzymes produced by the egg and to the host inflammatory response that forms granulomas in the venules [3]. In the acute phase, symptoms are relatively mild. But if the infection progresses to chronic stage, granulomas formation and fibrotic changes occur.

Local tissue invasion of eggs brings about the release of toxins and enzymes and provokes a TH-2 mediated response [4]. The immune response to S.mansoni and S.japonicum eggs in the liver causes the severe pathology of schistosomiasis [5].

Prevention

Schistosomiasis can be prevented by taking certain precautionary measures such as avoiding swimming, bathing or drinking directly from fresh water in endemic areas. Human waste should be properly eradicated and sprays and other insecticides should be used to kill the snail hosts wherever possible.

Summary

Schistosomiasis is the name of an infection caused by parasitic worms of the genus Schistosoma. It is also called Bilharzia, Katamaya Syndrome and Snail Fever. These worms may enter a person's body through contaminated water which is filled with Schistosoma species that are excreted into the water by infected snails, hence the name Snail Fever.

Once the parasitic worms have entered the body, they may cause an infection that presents with varying signs and symptoms, most common of which are diarrhoea, fever and abdominal pain. In some cases, patients may present with skin, genital or neurological symptoms as well.

Patient Information

Schistosomiasis is a very common infection by parasitic worms that live in freshwater, particularly in endemic areas like Africa and some parts of Latin America and Asia. The disease may begin with fever and bowel disturbances but may progress to liver and kidney damage, genital ulceration, skin infections and even neurological problems.

If you live in or have traveled to an endemic area and may have come in direct contact with fresh water there, and suddenly developed any of the symptoms mentioned above, it is recommended that you should visit a doctor immediately to get tested for schistosomiasis.

References

Article

  1. Fenwick A. The Global Burden of Neglected Tropical Diseases. Public Health 2012 126(3):233-6. 
  2. Nour NM. Schistosomiasis: Health effects on women. Reviews in obstetrics and gynaecology. 2010;3:28-32
  3. Warren L. Michael W, Harriet L, eds. Review of Medical Microbiology and Immunology. 11th edition. Chap.55 358-60
  4. Coutinho HM, Acosta LP, Wu HW, et al. Th2 cytokines are associates with persistent hepatic fibrosis in human Schistosoma japonicum infection. J Infect Dis. Jan 15, 2007. 195(2);288-95 
  5. Pearce EJ, MacDonald AS: The immune biology of schistosomiasis. Nat Rev Immunol 2:499, 2002
  6. Vennervald BJ, Dunne DW. Morbidity in schistosomiasis:an update. Cur Opin Infect Dis. Oct 2004: 17(5);439-47 
  7. Ross AG et al.: Schistosomiasis. N Engl J Med 346:1212, 2002 p.771.
  8. Robbin and Cotran Pathological Basis of Disease. 8th edition. 2004 p.247
  9. Ten Hove RJ, Verweij JJ, Vereecken K, et al. Multiplex real time PCR for the detection and quantification of S.mansomi and S.haematobium infection in stool samples collected in Northern Senegal. Trans R Soc Trop Med Hyg. 2008;102:179
  10. Olds GR. Administration of praziquantel to pregnant and lactating women. Acta Trop, May 2003:86:(2-3):185-95 

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Last updated: 2018-06-22 09:43