This document discusses a case of Schistosomiasis haematobium in a 25-year-old male from Kenya. Laboratory tests found eggs of S. haematobium in the patient's urine. The document then provides details on the life cycle, epidemiology, clinical manifestations, diagnosis, and treatment of schistosomiasis. Schistosomiasis remains a major public health problem worldwide, with certain areas of Africa and the Philippines having high infection rates. Praziquantel is the treatment of choice.

1. HX
●25 y/o African male
●Intermittant gross hematuria X 8 mo’s
●Dysuria and Increased Frequency
●Infantryman in Croatia since June 1994
●4 yrs ago treated for something similiar

2. HX
●Somali tribe of kenya (nomadic)
●Garrisa District (NorthEastern Province) of
Kenya
●Traveled widely in search of bride
●Had Swum in Tana River in past 4 yrs
approximately 15 times

3. Laboratory
●U/A (+) RBC’s, (-) WBC’s, (-) nitrites, (-)
leukocyte esterase
●U/A had single egg discovered in
multiple slides of centrifuged urine
●However, diagnositic specimen
●Schistosomasis hematobium

4. Schistosomiasis
Frank Meissner, LtCol, USAF, MC, FS
Emergency Medicine

5. The fact that illness is associated
with the poor-who are, from the
perspective of the privileged,
aliens in one's midst-reinforces
the association of illness with the
foreign: with an exotic, often
primitive place.
Susan Sontag

6. Introduction
●Chronic trematode (fluke) infection of
humans
●Major worldwide health problem
●Three major species Schistosoma
mansoni, S. japonicum, and S.
haematobium

7. Geographic Distribution
●S. mansoni - Africa, Arabia, South
America, and parts of the Caribbean
●S. japonicum - Japan, China, and the
Philippines
●S. haematobium - Africa and the Middle
East
●A minor species, S. mekongi - mainland
Indochina

8. Biology/Life Cycle

9. Epidemiology I
●Highly endemic, 2-3 million people
●Infection rates by region as high as 60%
●Risk elevated in rainy seasons March to
May and Late September to November

10. Epidemiology II
●Haematobium coastal plain and lower
Tana River Valley
●Taveta vicinity (extreme southwestern
Coast Province)
●Kitui District (Eastern Province)
●Nyanza Province (bordering Lake
Victoria)

11. Epidemiology III
●Intestinal Shistosomasis less widely
distributed
●Kitui and Machakos Districts (Eastern
Province)
●Taveta vicinity
●Bordering Lake Victoria
●Rusinga and Mfango Islands (Lake
Victoria)

12. Epidemiology
Garissa
District
Tana
River
Coast
Province
Kitui
District

13. Epidemiology

14. Clinical Features I
●Three stages of disease may occur
●First stage, schistosomal dermatitis
●Develops acutely within a day of
cercarial penetration of the skin
●Swimmer's itch, similar reaction in US
●26 percent of Michigan residents have
antischistosomal antibodies

15. Clinical Features II
●Second stage of disease
●Acute schistosomiasis, or Katayama
fever
●Four to eight weeks after heavy,
primary, infection
●Fever, cough, hepatosplenomegaly,
malaise, myalgias, urticaria, and
eosinophilia

16. Clinical Findings III
●Stage III - Chronic schistosomiasis
●Caused by heavy deposition of eggs in
intestine or bladder and in the liver
●S. haematobium infection, principal
symptoms -terminal hematuria, dysuria,
and frequency
●Hydronephrosis and pyelonephritis may
develop 2ndary fibrosis and infection

17. Non-Haematobium infection I
●S. mansoni, S. mekongi, or S.
japonicum infection
●Fever, malaise, abdominal pain,
diarrhea, or hepatosplenomegaly
●Presinusoidal hepatic trapping of eggs
●Granulomatous reaction induces portal
hypertension collateral esophageal
varices

18. Non-Haematobium infection II
●Eggs may be shunted from liver to lung,
with PAH
●Death 2ndary variceal bleeding
●Hepatic encephalopathy rare- hepatic
parenchyma spared
●Less common sequelae - intestinal
polyps, bladder carcinoma, persistent
Salmonella infections

19. Non-Haematobium infection III
●Infrequently, focal neurologic dysfunction
2ndary aberrant localization in CNS tissue
●Embolic deposition of S. japonicum eggs
may produce cerebral granulomas
●S. mansoni may lead to transverse
myelitis involving the midthoracic or
lumbar spinal cord

20. Diagnosis I
●Suggested - history of possible exposure
●Exposure may be years distant
●Compatable gastrointestinal or urinary
tract symptoms, hepatosplenomegaly,
eosinophilia, or combination of findings
●Serologic tests are rarely helpful

21. Diagnosis II
●Document presence of active infection
●=> find viable eggs
●Assess intensity of infection -quantitate
egg excretion

22. Diagnosis III
●Stool examination should include
search for all Schistosoma species
●S. haematobium, urine should be
obtained between 10:00 A.M. and 2:00
P.M.
●Microscopic examination of biopsy
specimens of rectal mucosa

23. Schistosoma haematobium

24. Treatment
●Praziquantel is drug of choice
●S. haematobium, single dose 40 mg/kg po
●S. japonicum, S. mansoni, and S. mekongi,
20 mg/kg po TID X 1 day
●Drug efficacious, paucity of side effects, is
convenient

25. Conclusions
●Geographic Medicine NOT Tropical
Medicine
●Detailed history of location and activities
important in making geographic
medicine diagnosis
●Knowledge of ecology of parasites
important

26. Meissner 6 W’s- ID Hx/o
●WHERE & WHEN? (travel history)
●You did WHAT WITH WHO, WHERE ?!!!!!!!!
(sexual history)
●WACKY WAYS to WASTE time?
(avocational/occupational history)

27. Meissner 6 W’s- ID Hx/o
●WEIRD and non-WEIRD WILDLIFE?
(Zoonoses)
●Wolfing WHAT? (food and ingestion history)
●WEAK-knead WIMP
(immunocompromised/immunosuppressed
host)