Download to read offline
More Related Content
Similar to SCHISTOSOMIASIS presentation, investigations to management.pptx
SCHISTOSOMIASIS presentation, investigations to management.pptx
- 1. SCHISTOSOMIASIS KAMPALA INTERNATIONAL UNIVERSITY, Lirateaching site PRESENTED BY: SSEKABIRA ABUD RASHID 2022-01-07616
- 2. outline Introduction Pathophysiology Clinical presentation Investigations Diagnosis Management Follow up and prognosis References
- 3. Introduction Dfn:- Anacute and chronic debilitating disease caused by infection with parasitic blood flukes/ trematode worms of the genus schistosoma. Also known as Bilharziasis after Theodor Bilharz-identified the parasite in 1852
- 4. Epidemiology A tropicallyneglected disease Atleast 300 million people are affected, 700 million people at risk, especially children and young adults. Second most disabling parasitic disease after malaria, with increasing prevalence due to population density and new irrigation- increases snail vector density Majority in Africa, over 4 million in Uganda
- 5. Epid… Prevalent intropical and subtropical areas, poor communities without access to safe water and proper sanitation Children are more vulnerable due to lack of hygiene, play habbits like swimming/ fishing in infested waters Especially school going and pre-school children.
- 6. pathophysiology Paediatric Schistosomiasis majorly takeson one of two forms; Intestinal (S. mansoni or S. japonicum), Urogenital (S. haematobium) Different schistoma species are prevalent in different geographical regions
- 8. Species and distribution SPECIESDISTRIBUTION Intestinal schistosomiasis S. mansoni Africa, the Middle East, the Caribbean, Brazil, Venezuela and Suriname S. Japonicum China, indonesia, philippines S. Mekongi D.R.C, Cambodia S. guineensis, S. intercalatum Central Africa Urogenital schistosomiasis S. Haematobium Africa, middle East, France
- 9. Life cycle Schistosomesare digenetic, with two hosts, man(definitive host for sexual reproduction) and some snail species as the intermediate host for asexual reproduction. byHuman become infected through penetration of the skin cercariae rather than through oral ingestion. The cerceriae, motile, forked-tail organisms emerge from infected snails to penetrate intact human skin.
- 10. Life cycle cont… Adult worms migrate to specific anatomic sites characteristic of each schistosome species: The human scistosomes can infect other vertebrates and provide an animal reservoir of infection (S.japonicum)
- 11. Life cycle cont… Schistosoma eggs are eliminated with feces or urine, depending on species. Eggs hatch and release miracidia, which swim and penetrate specific snail intermediate hosts-two generations of sporocysts and the production of cercariae in the snail. The infective cercariae are released(4-12 wks), swim, penetrate the skin of the human host , and shed their forked tails, becoming schistosomulae.
- 14. Life Cycle Cont… Schistosomulae migration: via venous circulation to lungs, heart, and then develop in the liver,& exit via the portal vein system when mature. Sexual stage: Male and female adult worms copulate and reside in the mesenteric venules (S. japonicum -superior mesenteric veins draining the SI, S. mansoni-inferior mesenteric veins of the LI, S. mansoni- pelvic pexus of the UB)
- 15. Cont… The eggsare moved progressively toward the lumen of the intestine (S. mansoni,S. japonicum, S. mekongi, S. intercalatum/guineensis) and of the bladder and ureters (S. haematobium), and are eliminated with feces or urine, respectively, THE CYCLE CONTINUES!!!!!!!
- 16. Granuloma formation Notall schistosome eggs are excreted from the body 50% can embolize to other body areas forming granulomas, causing ulceration in host tissues(bladder and intestine) Most common sites are the liver and the bladder Other less affected sites are the lungs, CNS and kidneys They involve the delayed hypersensitivity type of Type 1 (Th1) and Type 2(Th2) helper cell responses with local cytokine production
- 17.
- 18. Clinical presentation Symptomsof schistosomiasis are not caused by the worms themselves but by the body’s reaction to the eggs. Takes two clinical syndromes; Intestinal (S. mansoni or S. japonicum) Urogenital (S. haematobium) Incubation period 14-84 days Many infections are asymptomatic.
- 19. Clinical Cont… Schistosomaldermatitis/ swimmer’s itch A local cutaneous hypersensitivity reaction with itchy maculopapular lesions occurs following skin penetration by cercariae Occasionally, systemic hypersensitivity reaction may occur weeks after the initial infection(Katayama fever), especially by S. mansoni and S. japonicum
- 20.
- 21. Katayama fever A.k.aacute schistosomiasis, mostly in heavily infested individuals, 4-8 weeks after exposure. Is a febrile illness due to oviposition and early infection Characterised by a serum- like syndrome with acute onset of fever, cough, chills, sweating, abdominal pain, lymphadenopathy, hepatomegaly and eosinophilia.
- 22. chronic Intestinal presentation Colicyabdominal pain Bloody diarhhoea Hematemesis Hepatomegaly Portal hypertension Ascites Melana
- 23. Non- organ specificsymptoms Anaemia Chronic pain Diarhhoea Exercise intolerance Chronic under nutrition(growth stunting)
- 24. Chronic Urogenital presentation Urinaryfrequency, dysuria, terminal hematuria Referrred suprapubic/perineal pain
- 25.
- 26.
- 27. Complications Female genitalschistosomiasis- granulomatous inflammatory response,contact bleeding, pain and infertility- starts at 10 years Male schistosomiasis- hematospermia, pain, lumpy semen. Liver disease- due to granuloma formation and periportal fibrosis. Eggs in lungs causes pulmonary HTN and cor pulonale. CNS seizures due to CNS migration of eggs.
- 28. NOTE Advanced stagesof urogenital schistosomiasis are associated with chronic renal failure, secondary infections and squamous carcinoma of the bladder
- 29. Investigations Urinalysis- around10 mls of urine colected at midday(time of maximum egg deposition) Stool analysis (blood, melena, eggs depending on worm burden) CBC (eosinophilia, thrombocytopenia, anemia) Prolonged PT Normal or slightly elevated serum bilirubin and transaminases
- 30. Lab cont… Theunique schistosome antigens circulating anodic antigen (CAA) and circulating cathodic antigen (CCA) may also be detected in the urine or plasma. PCR assays- 99.9% specific, 94.4% sensitive for the diagnosis of schistosomiasis.
- 31. Imaging. CT (R/O pulmonary disease and brain involvement) Ultrasonography MRI (granulomas in brain, lungs,liver, spinalcord—ring enhancing lesions)
- 32. Imaging cont… IVpyelography (hydronephrosis, calcifications and filing defects) Endoscopy, sigmoidoscopy, bronchoscopy, colonoscopy Histology of liver biopsy
- 33. Management(pharmacological ) Praziquantel 20mg/kgBD on day 1 for S.haematobium, S intercalatum,and S mansoni 20 mg/kg orally TDS on day 1 for S japonicum and S mekongi. Children <5 years may need 60mg/kg/day to achieve clearence
- 34. Mgt cont… Monitorpatients for seizures or neurologic sequelae Corticosteroids to control post treatment inflammation Give second dose of drug 4-6weeks after 1st dose because immature forms are less susceptible
- 35. Surgical management Surgery(resection of bladder and colonic polyps) Correction of obstructive uropathy Partial colectomy for intestinal polyps Resection of cerebral cortical granulomas after failure of chemotherapy
- 36. Surgical mgt cont… Placement of a distal spleno-renal shunt for reversal of Portal Hypertension Consult with other specialits…
- 37. Follow up andprognosis. Prognosis is generally good Acute schistosomiasis is associated with a mortality rate of up to 25% in some series Repeat stool and urinalysis for 1 year post treatment for decreased egg excretion Monitor antigen levels
- 38. Prevention. Currently novaccine against schistosomiasis Prevention can be achieved by reducing the parasite load in the population by single dose anti parasitics. Focal application of molluscicidals Animal vaccination Creating awareness about the risks and access to clean water and proper sanitation are the best prevention measures to overcome the burden. Reduce exposure to contaminated water
- 39. references Kleigman.R.M, STGeme III.J.W, Blum.N,2019. Nelson Textbook of Paediatrics 21st Edition, Pg 7515-7522 World Health Organisation. (2023, February,1st ). Schistosomiasis. Retrieved from https://www.who.int/news-room/fact-sheets/detail/sc histosomiasis#:~:text=Schistosomiasis%20is%20an%20acu te%20and%20chronic%20parasitic%20disease%20caused% 20by,will%20reduce%20and%20prevent%20morbidity . Center for Disease Control. (2020,October, 28th ). Parasites- Schistosomiasis. Retrieved from https://www.cdc.gov/parasites/schistosomiasis/health_ professionals/index.html#:~:text=If%20the%20pre%2Dtre atment%20stool,to%20help%20confirm%20successful%20c ure .