RNT lecture schistosomiasis 2012 pdf small

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Schistosomes and
other flukes

Rahajeng N. Tunjungputri, MD, MSc

Department of...

Case
 A 22-year-old student from Sulawesi presented at
the hospital with acute haematemesis
 Physical examinatio...

S. mansoni

Human schistosomiasis/
Schistosomes S. japonic...

Human schistosomiasis: epidemiology
 200 million persons infected with schistosomes in 74 countries
 120 million per...

 Water resource development projects and population
movements have spread the disease to non-endemic areas

Global distribution

Schistosomiasis in Indonesia
 1975: highest prevalence  72%
 Domestic and wild animals maintain
transmission cy...

Snail habitat

Schistosomes morphology
 Male
 9,5mm x 19,5 mm
 Canalis gynecophorus

 Female : 16 mm x 26 mm
 Thin-s...

S. mansoni
 Habitat
 Mesenteric and portal veins
 V. mesenterica inferior

S. mansoni

S. mansoni male adult: tegument

S. japonicum

 Habitat
 Mesenteric and portal veins
 V. mesenterica superior

S. haematobium
 Habitat
 V. vesicalis

Life cycle
Video

Cercariae
penetration

Intensity of
infection

Severity of
disease

In snails: sporocyst I 
sporocyst ...

 Transmission

Clinical manifestation
Period Affected organ Manifestation

Immediate Skin Dermatitis...

Pathogenesis
 Egg production commences four to six weeks after infection
and continues for the life of the worm — u...

Gastrointestinal and liver disease
 Intestinal disease: Eggs in the gut wall  inflammation,
hyperplasia, ulceratio...

Adult in
mesenteric
veins

Eggs in
venulae/ tissue

Inflammation

Portal hypertension,
variceal bleeding

 Hepatomegaly
 Varices
...

Genitourinary Disease
 Dysuria and hematuria (early and late disease)
 Late manifestations:
 proteinuria (often...

Schistosomal dermatitis

http://img.medscape.com/pi/emed/ckb/pediatrics_general/996090-999469-98.jpg

Schistosomal dermatitis

 http://upload.wikimedia.org/wikipedia/commons/5/5a/Cercarial_dermatitis_lower_legs.jpg

GU disease
 27-year-old man with hematuria and left-sided loin
pain who had S. haematobium eggs in his urine

Liver disease
 ultrasonogram showing gross hepatic fibrosis
(arrows) in a 45-year-old man with severe hepatic
s...

Diagnosis: Schistosomiasis
 Eggs in stool
 Multiple samples
 Others:
 PCR

 Serology - ELISA

Schistosomiasis control

 Indonesia
 2 times /year: Human stool survey, Snails survey, Reservoir host
surv...

Other liver flukes

Clonorchis sinensis
 flattened
 10-25 mm long by 3-5 mm wide
 ovary
 two branches testes
 habitat: bile duc...

Opistorchis spp.
 Testes: 2, lobular shape
 Eggs often indistinguishable
from C. sinensis
 Habitat: bile ducts

Opisthorchiasis and Clonorchiasis
 2-3 weeks after exposure
 Fever, abdominal pain, hepatomegaly, urticaria, and
...

 Infection:
 ingesting the
metacercariae in
raw or
inadequately
cooked fish

Fasciola hepatica

 large and broadly-flat
 up to 30 mm x 15 mm
 The anterior end is cone-
shaped
 Habitat...

 ingesting
uncooked
aquatic
vegetation

Clinical syndromes of F. hepatica infection

• In 6-12 weeks after infection: Marked
...

Diagnosis: other liver flukes
 Finding eggs in stool
 Multiple samples

Treatment

 Schistosomiasis: Praziquantel repeated dose after 4-6 weeks in Katayama fever
 Niridazol for schistos...

Case: Examination of stool specimens

Serology
 Enzyme immunoassay high levels of serum
antibodies to S. mansoni were subsequently
detected

Therapy
 Endoscopy sclerotherapy
 Pharmacotherapy

Reference
 Mandell GL, Bennet JE, Dolin R. Principles and practice of
infectious diseases. 2010 Ed. 7 pp. 3595-3605...

RNT lecture schistosomiasis 2012 pdf small

RNT lecture schistosomiasis 2012 pdf small

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