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SCHISTOSOMIASIS/
   BILHARZIOSIS
              BY:
       INUSAH ADAMS
      4th yr med. Student
        TDMU, Ukraine
         DEC, 1ST, 2012
             TDMU
Bilhazia in Ghana
PLAN OF PRESENTATION
 DEFINITION
 EPIDEMIOLOGY
 ETIOLOGY
 MODE OF TRANSMISSION/LIFE CYCLE
 PATHOGENESIS
 SIGNS &SYMPTOMS
 DIAGNOSIS
 DIFFERENTIALS
 TREATMENT
 COMPLICATIONS
 PROGNOSIS
DEFINITION
• Schistosomiasis is a chronic, parasitic
  disease caused by blood flukes
  (trematode worms) of the genus
  Schistosoma
• Also, called snail fever
EPIDEMEOLOGY
The disease is found in Africa, South
 America, East Asia and Middle East
Over 230 million people require
 treatment for schistosomiasis yearly
90% of those requiring treatment for
 schistosomiasis live in Africa.
More than 200,000 deaths per year
 are due to schistosomiasis in sub-
 Saharan Africa
ETIOLOGY
• Parasitic worms of schistosoma species
Main species are;
a. Schistosoma haematobium
b. Schistosoma mansoni
c. S. japonicum
d. S. mekongi and
e. S intercalatum
Two forms of schistosomiasis exist

 1. Intestinal schistosomiasis and
  2. Urogenital schistosomiasis
SCHISTOSOMA MANSONI (lateral spine)
SCHISTOSOMA HAEMATOBIUM(terminal spine)




     • TT
RISK FACTORS
• wading or swimming in lakes, ponds and
  other bodies of water which are infested
  with the snails

• Fishing (both men and women)
• Women washing clothes in infested water
  are at risk
• People with STIs
LIFE CYCLE
• : parasite eggs are released(by way of urination
  or defecation) into the environment from infected
  individuals.
• The eggs hatch on contact with fresh water to
  release the free-swimming miracidium
• Miracidium penetrates a water snail tissue where
  it develops into cercaria
• Cercaria is release into the water from the snail
• cercaria penetrates the skin of human (definitive
  host), circulate to organs (GIT, urinary tract)
LIFE CYCLE
LIFE CYCL con’t
Schistosoma dermatitis or “swimmers itch”
1.
           PATHOGENESIS forms of the
     People become infected when larval
     parasite – released by freshwater snails – penetrate
     their skin during contact with infested water.
2.   the larvae develop into adult schistosomes
3.   Adult schistosomes live in the blood vessels where
     the females release eggs
4.   Some of the eggs are passed out of the body in the
     faeces or urine to continue the parasite life-cycle
5.    Others become trapped in body tissues (intestinal
     and urinary system), causing an immune reaction
     and progressive damage to organs.
SIGNS & SYMPTOMS
     • Clinical picture: low grade fever. Fatigue, weight loss and
                                 anemia
               • INTESTINAL SCHISTOSOMIASIS
1.    Abdominal pain
2.    Diarrhea
3.    Blood in stool, fresh or melena
4.    Hematemesis
5.    Liver enlargement
                UROGENITAL SCHISTOSOMIASIS
1.    Hematuria (terminal)
2.    dysuria
3.    Frequent need to urinate (polykauria)
4.    In females; genital lesions, vaginal bleeding, pain during
      sexual intercourse and nodules on the vulva, irregular
      menstruation
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 may stop
   and recur in a week, month or year time)
• Urolithiasis (colicky pain)
              INTESTINAL SCHISTOSOMIASIS
• Peptic ulcer disease (heartburns, GERD,
 endoscopically, ulcer in GIT)
• Pancreatitis (H-like pain, vomiting that is worsened with
   eating, high diastase level, etc.)
• cutaneous leishmaniasis (non-healing raised, scaling lesions on
   the skin)
DIAGNOSTIC PLAN
1.    stool examination for S. mansoni and ova
2.    Urinalysis and urine for S. hematobium and ova
3.    General blood analysis:
4.    Serological: hemagglutination test; reaction is positive @ a
      dilution of 1: 16 or more
5.    BUN and creatinine level
6.    Ureterocystoscopy
7.    Biopsy of rectum or urinary bladder
8.    Plain abdominal X-ray: chronic cases may show calcification
      and fibrosis of ureters, urinary bladder, ascites
9.    Intravenous urography: may show the level of ureter stricture
10.   Ultrasound of abdomen: hepatosplenomegaly, bilharzial
      hepatic fibrosis, ascites
clusters of the parasite eggs with
      intense eosinophilia
Calcification of the urinary bladder
Yellow raised nodules surrounded by a
halo of hyperemia (TB of bladder)
Cystoscopy in tumor of kidney
     (gross hematuria)
TREATMENT
• Drug:     Prazequnatel
          Dose: 40mg/kg single oral dose

60mg/kg in 2 divided doses if
 quantity of ova is high

Review in 2 weeks
Urogenital schistosomiasis
1.   cystitis
2.   Urinary bladder cancer
3.   Polyps, ulcers of urinary bladder
4.   Hemospermia
5.   Infertility
6.   Spontaneous abortion
7.   Renal failure
8.   anemia


                         Intestinal schistosomiasis
1.   Liver fibrosis
2.   Intestinal cancer
3.   Portal hypertension/Pulmonary hypertension/ Cor pulmonale
4.   Ascites
5.   Esophageal varices
6.   Malnutrition

COMPLICATIONS
• Always good especially with prompt
  diagnosis and treatment




         PROGNOSIS
PREVENTION
Education
Eliminating the water-borne snails which are
 natural reservoirs for the disease
Annual dose of prazequantel
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 )
• GHANA AND BILHARZIA
Schistosomiasis

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Schistosomiasis

  • 1. SCHISTOSOMIASIS/ BILHARZIOSIS BY: INUSAH ADAMS 4th yr med. Student TDMU, Ukraine DEC, 1ST, 2012 TDMU
  • 3. PLAN OF PRESENTATION  DEFINITION  EPIDEMIOLOGY  ETIOLOGY  MODE OF TRANSMISSION/LIFE CYCLE  PATHOGENESIS  SIGNS &SYMPTOMS  DIAGNOSIS  DIFFERENTIALS  TREATMENT  COMPLICATIONS  PROGNOSIS
  • 4. DEFINITION • Schistosomiasis is a chronic, parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma • Also, called snail fever
  • 5. EPIDEMEOLOGY The disease is found in Africa, South America, East Asia and Middle East Over 230 million people require treatment for schistosomiasis yearly 90% of those requiring treatment for schistosomiasis live in Africa. More than 200,000 deaths per year are due to schistosomiasis in sub- Saharan Africa
  • 6. ETIOLOGY • Parasitic worms of schistosoma species Main species are; a. Schistosoma haematobium b. Schistosoma mansoni c. S. japonicum d. S. mekongi and e. S intercalatum
  • 7. Two forms of schistosomiasis exist 1. Intestinal schistosomiasis and 2. Urogenital schistosomiasis
  • 10. RISK FACTORS • wading or swimming in lakes, ponds and other bodies of water which are infested with the snails • Fishing (both men and women) • Women washing clothes in infested water are at risk • People with STIs
  • 11. LIFE CYCLE • : parasite eggs are released(by way of urination or defecation) into the environment from infected individuals. • The eggs hatch on contact with fresh water to release the free-swimming miracidium • Miracidium penetrates a water snail tissue where it develops into cercaria • Cercaria is release into the water from the snail • cercaria penetrates the skin of human (definitive host), circulate to organs (GIT, urinary tract)
  • 12.
  • 15.
  • 16. Schistosoma dermatitis or “swimmers itch”
  • 17. 1. PATHOGENESIS forms of the People become infected when larval parasite – released by freshwater snails – penetrate their skin during contact with infested water. 2. the larvae develop into adult schistosomes 3. Adult schistosomes live in the blood vessels where the females release eggs 4. Some of the eggs are passed out of the body in the faeces or urine to continue the parasite life-cycle 5. Others become trapped in body tissues (intestinal and urinary system), causing an immune reaction and progressive damage to organs.
  • 18. SIGNS & SYMPTOMS • Clinical picture: low grade fever. Fatigue, weight loss and anemia • INTESTINAL SCHISTOSOMIASIS 1. Abdominal pain 2. Diarrhea 3. Blood in stool, fresh or melena 4. Hematemesis 5. Liver enlargement UROGENITAL SCHISTOSOMIASIS 1. Hematuria (terminal) 2. dysuria 3. Frequent need to urinate (polykauria) 4. In females; genital lesions, vaginal bleeding, pain during sexual intercourse and nodules on the vulva, irregular menstruation
  • 19. 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 may stop and recur in a week, month or year time) • Urolithiasis (colicky pain) INTESTINAL SCHISTOSOMIASIS • Peptic ulcer disease (heartburns, GERD, endoscopically, ulcer in GIT) • Pancreatitis (H-like pain, vomiting that is worsened with eating, high diastase level, etc.) • cutaneous leishmaniasis (non-healing raised, scaling lesions on the skin)
  • 20. DIAGNOSTIC PLAN 1. stool examination for S. mansoni and ova 2. Urinalysis and urine for S. hematobium and ova 3. General blood analysis: 4. Serological: hemagglutination test; reaction is positive @ a dilution of 1: 16 or more 5. BUN and creatinine level 6. Ureterocystoscopy 7. Biopsy of rectum or urinary bladder 8. Plain abdominal X-ray: chronic cases may show calcification and fibrosis of ureters, urinary bladder, ascites 9. Intravenous urography: may show the level of ureter stricture 10. Ultrasound of abdomen: hepatosplenomegaly, bilharzial hepatic fibrosis, ascites
  • 21. clusters of the parasite eggs with intense eosinophilia
  • 22. Calcification of the urinary bladder
  • 23.
  • 24.
  • 25. Yellow raised nodules surrounded by a halo of hyperemia (TB of bladder)
  • 26. Cystoscopy in tumor of kidney (gross hematuria)
  • 27. TREATMENT • Drug: Prazequnatel Dose: 40mg/kg single oral dose 60mg/kg in 2 divided doses if quantity of ova is high Review in 2 weeks
  • 28. Urogenital schistosomiasis 1. cystitis 2. Urinary bladder cancer 3. Polyps, ulcers of urinary bladder 4. Hemospermia 5. Infertility 6. Spontaneous abortion 7. Renal failure 8. anemia Intestinal schistosomiasis 1. Liver fibrosis 2. Intestinal cancer 3. Portal hypertension/Pulmonary hypertension/ Cor pulmonale 4. Ascites 5. Esophageal varices 6. Malnutrition COMPLICATIONS
  • 29. • Always good especially with prompt diagnosis and treatment PROGNOSIS
  • 30. PREVENTION Education Eliminating the water-borne snails which are natural reservoirs for the disease Annual dose of prazequantel 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 )
  • 31. • GHANA AND BILHARZIA