SchistosomiasisSchistosomiasis

ByBy

Mohammed Mahmoud, MDMohammed Mahmoud, MDLecturer of tropical MedicineLecturer of tropical Medicine

Cairo universityCairo university

Specices & DistributionSpecices & Distribution

S. MansoniS. Mansoni : Nile valley, Sudan, Brazil and : Nile valley, Sudan, Brazil and VenzezuellaVenzezuella

S. HaematobiumS. Haematobium: Upper Egypt, Africa, : Upper Egypt, Africa, Western AsiaWestern Asia

S. Japonicum:S. Japonicum: Far East Far East

Life CycleLife Cycle

Basic pathologyBasic pathology

Cercaria Cercaria Allergic dermatitis Allergic dermatitis AdultsAdults No harm No harm EggsEggs granulomas granulomas Fibrosis Fibrosis

egg antigens egg antigens immune complexes immune complexes Katayama feverKatayama fever

Clinical pictureClinical picture

Cercarial dermatitisCercarial dermatitis: pruritic rash occurs : pruritic rash occurs within 24 h of cercarial penetrationwithin 24 h of cercarial penetration

Katayama fever:Katayama fever:- Usually with S. japonicum (???)- Usually with S. japonicum (???)- Heavy infection with mansoni- Heavy infection with mansoni- Occur in non-immune persons- Occur in non-immune persons- 4-6 weeks after primary infection (time of egg - 4-6 weeks after primary infection (time of egg

deposition)deposition)- Fever, rigors, HSM, LN, ulticarial rash, marked - Fever, rigors, HSM, LN, ulticarial rash, marked

eosionophiliaeosionophilia

Urogenital schistosomiasis:Urogenital schistosomiasis:- S.haematobium- S.haematobium- affect UB, ureter, genital organs- affect UB, ureter, genital organs- Dysuria, terminal haematuria- Dysuria, terminal haematuriaComplications:Complications:

1- Obstructive uropathy1- Obstructive uropathy2- Cancer bladder (squamous cell)2- Cancer bladder (squamous cell)

Intestinal schistosomiasis:Intestinal schistosomiasis:- caused by mansoni- caused by mansoni- affect large bowel (rectum and sigmoid)- affect large bowel (rectum and sigmoid)- due to submucosal egg deposition - due to submucosal egg deposition granumonagranumona fibrosis fibrosis- Clinically:- Clinically:

1- 1- Bilharzial dysenteryBilharzial dysenterydysentery, tensmus, mucus in stools, dysentery, tensmus, mucus in stools, crampy crampy

abdominal painabdominal pain

2- 2- Colonic polyposisColonic polyposisBloody diarrhea, anemia, hypoprotinemia, clubbing of Bloody diarrhea, anemia, hypoprotinemia, clubbing of

fingers (never turn malig)fingers (never turn malig)

3- 3- Bilharzioma:Bilharzioma:Tender palpable mass in Lt iliac fossaTender palpable mass in Lt iliac fossaNever turn malignantNever turn malignant

Hepatic schisosomiasis Hepatic schisosomiasis Caused by S. Mansoni, S. JaponicumCaused by S. Mansoni, S. Japonicum Stages:Stages:

1- 1- Stage of hepatomeglyStage of hepatomegly::ovideposition and granuloma formationovideposition and granuloma formationliver is enlarged, smooth, firm, rounded edge.liver is enlarged, smooth, firm, rounded edge.

2- 2- Stage of HSMStage of HSM (Mainly due RES) (Mainly due RES)

3- 3- Stage of Huge splenomeglyStage of Huge splenomegly (PH) (PH) and shrunken liver (periportal fibrosis) and PS collaterals. and shrunken liver (periportal fibrosis) and PS collaterals.

4- 4- Stage of ascitesStage of ascites (PH and hypoprotinemia, late due to malnutrition, loss of proteins by colonic polyposis (PH and hypoprotinemia, late due to malnutrition, loss of proteins by colonic polyposis and haematemesis)and haematemesis)

5- 5- Terminal hepatic failureTerminal hepatic failureconcomitant viral hepatitisconcomitant viral hepatitisReversal of the blood flow away from the liver (PS)Reversal of the blood flow away from the liver (PS)

Periportal fibrosisPeriportal fibrosis

Paraumbilical veinParaumbilical vein

Oesophageal varicesOesophageal varices

Cardiopulmonary SchistosomiasisCardiopulmonary Schistosomiasis

Larval PneumonitisLarval Pneumonitis: allery to schistosomulae : allery to schistosomulae migrationsmigrations low grade fever, cough, haemoptysis, low grade fever, cough, haemoptysis, wheezes, eosionophiliawheezes, eosionophilia

Core pulmonaleCore pulmonale: due to eggs of S. mansoni (reach : due to eggs of S. mansoni (reach through PS collaterals), S. haemtobiumthrough PS collaterals), S. haemtobiumpulmonary arteriolespulmonary arterioles granuloma granuloma fibrosis fibrosis endertaritis oblitrans endertaritis oblitrans pulmonary HT pulmonary HT RVH RVH RVFRVFX-ray X-ray dilatation of main pulmonary arteries dilatation of main pulmonary arteries (Dumble shape masses at the hilum)(Dumble shape masses at the hilum)

Schistosomal corepulmonaleSchistosomal corepulmonale

Ectopic SchistosomiasisEctopic Schistosomiasis

Due to aberrant migration of the eggsDue to aberrant migration of the eggs Mainly affect brain (seizures), spinal cord Mainly affect brain (seizures), spinal cord

(paraplegia), eye (visual field defects), skin.(paraplegia), eye (visual field defects), skin.

Chronic salmonellosisChronic salmonellosis

Salmonella behave atypical in cases of Salmonella behave atypical in cases of schistosomiasis following a rather chronic schistosomiasis following a rather chronic course unlike the usual acute illness course unlike the usual acute illness

Due to proliferation of salmonella in the gut of Due to proliferation of salmonella in the gut of the adult schistosomes, shedding salmonella the adult schistosomes, shedding salmonella into blood into blood chronic bacteraemia chronic bacteraemia prolonged feverprolonged fever

Ttt by antityphoid to eradicate salmonella and Ttt by antityphoid to eradicate salmonella and prevent relapse by antischistosomal therapy. prevent relapse by antischistosomal therapy.

DiagnosisDiagnosis

Stool and urine examinationStool and urine examination Rectal snipRectal snip (gold standard) (gold standard) Liver biopsyLiver biopsy Serological tests:Serological tests:

Ab detectionAb detection donot differentiate between active donot differentiate between active and past infection, did not decrease after tttand past infection, did not decrease after ttt

Ag detection Ag detection indicate active infection and indicate active infection and decrease after successful tttdecrease after successful ttt

TreatmentTreatment

Praziquantel Praziquantel (Drug of choice)(Drug of choice)

for both mansoni and haematobium, 40 mg/kg, for both mansoni and haematobium, 40 mg/kg, can be repreated 2 or 3 times in moderate and can be repreated 2 or 3 times in moderate and severe infectionssevere infections

MetrifonateMetrifonate: for S.haematobium 10 mg/kg in 3 : for S.haematobium 10 mg/kg in 3 repeated doses at 2 weeks intervalrepeated doses at 2 weeks interval

OxamniquineOxamniquine: for mansoni 20 mg/kg daily for : for mansoni 20 mg/kg daily for 3 days3 days

Thank youThank you