1. Ahmed Adel Fouad Abdelhakeem

2. Schistosomiasis, also known as bilharziasis
or snail fever, is a primarily tropical
parasitic disease caused by the larvae of
one or more of five types of flatworms or
blood flukes known as schistosomes.
 The name bilharziasis comes from
Theodor Bilharz, a German pathologist,
who identified the worms in 1851.


3. 
Schistosoma haematobium

Schistosoma mansoni

Schistosoma intercalatum

Schistosoma japonicum/Schistosoma
mekongi

5. Africa: most of the countries of North
Africa; widespread in Central and West
Africa; in eastern Africa present from
Somalia to the Cape and on the islands
offshore, including Madagascar and
Mauritius.
 Middle East: present in most countries.
 There might also be small foci in India
around Bombay and in Madras State.
 A total of about 90 million people are
infected worldwide.


6. Africa: North Africa
(Morocco, Tunisia, Egypt, southern
Sudan); East Africa (from Ethiopia down
to South Africa and Madagascar); most
countries of Central and West Africa.
 Middle East (Lebanon, Oman, Saudi
Arabia, Somalia, Yemen).
 Americas: in South America and some of
the Caribbean islands.


7. 
There are limited foci in :

Central Africa including
Cameroon, Congo, Congo Democratic
Republic (Zaire), Equatorial
Guinea, Gabon, and possibly in Central
African Republic, Chad, Mali and
Nigeria.

8. 
China, Indonesia.

Philippines.

Thailand.

10. 
The male measures 10–20 mm _ 0.9 mm
and the cuticle has fine tuberculations.
There are 4–5 testes.

The female has a long uterus, with the
ovary in the posterior third of the body.

There are 10–100 eggs in the uterus at
one time.

11. 




The adults are smaller than
those of the other species.
The male measures 6–13 mm _
0.75–1.0 mm and the cuticle has
coarse tuberculations.
There are 4–13 (usually 6–9)
testes.
The ovary of the female is
situated anteriorly.
There is usually only 1 egg in the
uterus at one time.

12. 
The male measures 12–20 mm _ 0.5–0.55
mm and has no cuticular tuberculations.

There are 6–7 testes.

The female has the ovary at about the
middle of the body. There are 5–200
eggs in the uterus at one time.

13. 
The male measures 11–14 mm _ 0.3–0.4
mm. There are 2–7 testes.

The female has 5–60 eggs in the uterus at
one time.

18. Ciliated miracidium.
Note anterior penetration glands.
Dark field. Actual size 80 m.

20. Adults of Schistosoma sp. in lung
tissue, stained with H&E
Higher magnification of one of the
worms, showing the tuberculate
exterior of the adult worm

21. S.
hematobium
Urinary

22. Intestinal
S. mekongi
S.
intercalatum
S. mansoni
S.
japonicum

24. 
A cercarial dermatitis (‘swimmer’s itch’)
may appear 24 h after first infection but
seldom lasts more than 48 h.

25. 
There are usually no symptoms until 5–10
weeks after infection, when there may
be mild allergic manifestations in visitors
but these are rare in indigenous
populations.

26. 
Maximum egg production begins 10–12
weeks after infection.

Haematuria (found in about 50% of
cases), dysuria and increased frequency
of micturition are typical clinical signs
and may persist intermittently for years.

hydroureter, hydronephrosis and
uraemia.

27. Schistosoma near urethra

28. Inner surface of the bladder showing nests of
calcified ova (‘sandy patches’) (arrowed) of S.
hematobium.

29. Intravenous pyelogram of a woman infected with S.
haematobium showing bilateral hydronephrosis
with deformity of both ureters.

30. Section of bladder. Eggs of S. haematobium (many are
calcified or ‘black’ eggs) can be seen
with epithelial squamous cell metaplasia (arrowed).

31. S. japonicum.
S. mekongi.
S. mansoni.
S. intercalatum

32. 
As for S. haematobium.

33. Allergic
manifestations
serum
sickness
Katayama
syndrome

34. 










portal hypertension with splenomegaly
oesophagial varices
hypersplenism
ascitis
pulmonary hypertension
CNS lesions: spine - transverse myelitis
cerebral – seizures (S. japonicum)
intestinal polyposis: both sessile and
pedunculated
chronic salmonellosis
intestinal granulomatosis: contractures of
colon, intusseception

35. Egg granuloma of S. mansoni in liver with
surrounding epitheloid cells and some leucocytic
infiltration

36. Granuloma in the liver due to Schistosoma mansoni.
The S mansoni egg is at the center of the granuloma.

37. Two boys with advanced schistosomiasis mansoni.
Note collateral venous circulation in nearest
patient.

39. 
The presence of eggs in the faeces or
urine is still the most widely used method
of diagnosis.

40. 
Schistosoma mansoni eggs are large
(114 to 180 µm long by 45-70 µm wide)
and have a characteristic shape, with a
prominent lateral spine near the
posterior end. The anterior end is
tapered and slightly curved. When the
eggs are excreted in stool, they contain
a mature miracidium.

42. 
The eggs of Schistosoma haematobium
are large (110-170 µm long by 40-70 µm
wide) and bear a conspicuous terminal
spine. Eggs contain a mature
miracidium when shed in urine.

44. 
The eggs of Schistosoma japonicum are
large and more rounded than other
species, measuring 70-100 µm long by
55-64 µm wide. The spine on S.
japonicum eggs is smaller and less
conspicuous than other species. Eggs
are shed in stool.

46. 
Schistosoma intercalatum is related to S.
haematobium, but restricted to eastcentral Africa. The eggs are similar to S.
haematobium in general shape and in
possessing a terminal spine, but are
usually longer (140-240 µm), often have
an equatorial (central) bulge and are
shed in stool, not urine.

48. 
Sedimentation

Ceroscopy

Rectal biopsy

50. hematuria (terminal)
 urinary frequency
 pyuria
 pyelonephritis
 obstructive uropathy
 cancer of bladder (squamous cell)
 distant metastases (spinal column)
 (pulmonary hypertension)


51. History of freshwater exposure
 portal hypertension with splenomegaly
 oesophagial varices
 hypersplenism
 ascitis
 pulmonary hypertension
 CNS lesions: spine - transverse myelitis
 cerebral – seizures (S. japonicum)


52. 
ELISA & immunoblotting techniques are
the most convenient.

A dipstick ELISA for urine samples, using
an SEA can effectively diagnose
schistosomiasis and correlates well with
quantitative egg counts.

Circulating cathodic antigen (CCA)

53. Chemotherapy
Surgery

54. Praziquantel
Metrifonate
Atropine
sulphate
Oxamniquine

55. 
Intrinsic Factors (deal with man)
Extrinsic factors (snail control):
 Mechanical control
 Biological control
 Chemical control (molluscicides)
