This document provides an overview of schistosomiasis (snail fever) including:
- It is caused by several species of parasitic flatworms (schistosomes) and transmitted through contact with contaminated fresh water.
- The life cycle involves freshwater snails acting as intermediate hosts. Symptoms vary depending on the infecting species and stage of infection.
- Acute infection causes flu-like symptoms while chronic infection can lead to organ damage like liver fibrosis, bladder cancer, and renal failure due to the host immune response against schistosome eggs.
What is fascioliasis?
In what parts of the world if fascioliasis found?
How do people get infected with fascioliasis?
What are the signs and symptoms of Fasciola infection, and when do they begin?
How is Fasciola infection diagnosed?
Can Fascioliasis be treated?
How can fasciola infection be prevented?
What is fascioliasis?
In what parts of the world if fascioliasis found?
How do people get infected with fascioliasis?
What are the signs and symptoms of Fasciola infection, and when do they begin?
How is Fasciola infection diagnosed?
Can Fascioliasis be treated?
How can fasciola infection be prevented?
What is Fifth disease, what is erythema infectiosum What is the causative factor, pathophysiology ,clinical presentation ,diagnosis ,laboratory investigations ,treatment , precautions and prognosis ,
Staphylococcal Scalded Skin Syndrome Made Very EasyDrYusraShabbir
A brief description of a very common bacterial skin condition affecting children and adults. Characterized by fever, rash and peeling of the skin. Useful information for medical students, doctors especially dermatologists and pediatricians and nurses. Helpful information for exam preparation of USMLE, FCPS, MCPS, MRCP derma.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
What is Fifth disease, what is erythema infectiosum What is the causative factor, pathophysiology ,clinical presentation ,diagnosis ,laboratory investigations ,treatment , precautions and prognosis ,
Staphylococcal Scalded Skin Syndrome Made Very EasyDrYusraShabbir
A brief description of a very common bacterial skin condition affecting children and adults. Characterized by fever, rash and peeling of the skin. Useful information for medical students, doctors especially dermatologists and pediatricians and nurses. Helpful information for exam preparation of USMLE, FCPS, MCPS, MRCP derma.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
Babesiosis, caused by infection with intra erythrocytic parasites of the genus Babesia, is one of the most common infections of free living animals worldwide and is gaining increasing interest as an emerging zoonosis in humans. this is a detailed study on this ......considering all the facts such as definition , management, parthenogenesis, diagnosis, treatment, prevention , etc
please comment
thank u
The slide is about enteric fever, also called typhoid fever. It explains the relevant anatomy, pathogenesis, pathophysiology, presentation, diagnosis and treatment of the disease. It also specifies the prevention by way of lifestyle and vaccines
Toxoplasmosis is a parasitic infection that causes flu-like symptoms. It can be spread by eating raw or undercooked meats or shellfish, consuming contaminated food and water, or through contact with cat feces. Most people who get toxoplasmosis will have no symptoms or very mild symptoms
Briefly describe the pathogenesis of typhoid fever when the bacteria.pdfarjunenterprises1978
Briefly describe the pathogenesis of typhoid fever when the bacteria are ingested. Include what
happens to an infected individual systemically and how the person succumbs to the infection.
Solution
Typhoid fever :
Typhoid fever, otherwise called enteric fever, is a possibly lethal multisystemic ailment brought
about essentially by Salmonella enterica, subspecies enterica serovar typhi and, to a lesser
degree, related serovars paratyphi A, B, and C.
The mutable appearances of typhoid fever make this malady a genuine symptomatic test. The
exemplary presentation incorporates fever, disquietude, diffuse stomach torment, and clogging.
Untreated, typhoid fever is an overwhelming sickness that may advance to daze, obtundation,
intestinal discharge, inside puncturing, and passing inside 1 month of onset. Survivors might be
left with long haul or changeless neuropsychiatric confusions.
All pathogenic Salmonella species, when present in the gut are overwhelmed by phagocytic
cells, which then go them through the mucosa and present them to the macrophages in the lamina
propria. Nontyphoidal salmonellae are phagocytized all through the distal ileum and colon. With
toll-like receptor (TLR)–5 and TLR-4/MD2/CD-14 complex, macrophages perceive pathogen-
related atomic examples (PAMPs, for example, flagella and lipopolysaccharides. Macrophages
and intestinal epithelial cells then pull in T cells and neutrophils with interleukin 8 (IL-8),
bringing about irritation and smothering the contamination.
As opposed to the nontyphoidal salmonellae, S typhi and paratyphi enter the host\'s framework
fundamentally through the distal ileum. They have particular fimbriae that stick to the epithelium
over groups of lymphoid tissue in the ileum (Peyer patches), the primary transfer point for
macrophages going from the gut into the lymphatic framework. The microscopic organisms then
actuate their host macrophages to pull in more macrophages.
S typhi has a Vi capsular antigen that veils PAMPs, keeping away from neutrophil-based
irritation, while the most well-known paratyphi serovar, paratyphi A, does not. This may clarify
the more prominent infectivity of typhi contrasted and the majority of its cousins.
Typhoidal salmonella co-pick the macrophages\' cell apparatus for their own particular
proliferation as they are helped through the mesenteric lymph hubs to the thoracic conduit and
the lymphatics and after that through to the reticuloendothelial tissues of the liver, spleen, bone
marrow, and lymph hubs. Once there, they interruption and keep on multiplying until some basic
thickness is come to. A while later, the microorganisms incite macrophage apoptosis, breaking
out into the circulatory system to attack whatever remains of the body. The microorganisms then
taint the gallbladder by means of either bacteremia or direct expansion of contaminated bile. The
outcome is that the living being re-enters the gastrointestinal tract in the bile and reinfects Peyer
patches.
Constant tr.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
4. Schistosomiasis or
( Snail Fever ) is an
important cause of
disease in many parts
of the world, most
commonly in places
with poor sanitation.
School-age children who live in these areas are often
most at risk because they tend to swim or bath in water
containing infectious cercariae.
If you live in, or travel to, areas where Schistosomiasis
is found & are exposed to contaminated freshwater,
you are at risk.
5. Areas where human Schistosomiasis is found include:
S.Mansoni & S.Haematobium distributed throughout Africa.
There is risk of infection in freshwater in southern & sub-
Saharan Africa–including the great lakes & rivers as well
as smaller bodies of water.
6. In Sudan specially, due to
agriculture & irrigation of
cannels creating a favorable
environment for snails.
The highest Schistosoma
prevalence is in:
- Al-Jazeera state.
- White Nile state.
- River Nile state specially
after Marawi dam.
7. Transmission also occurs in the Nile
River valley in Sudan, Egypt & the
Maghreb region of North Africa.
South America: including Brazil,
Suriname, Venezuela Caribbean.
In areas of East of Asia:
S. japonicum found in Indonesia,
parts of China & Southeast Asia.
S.Mekongi found in
Cambodia & Laoss.
Intercalatum found in parts
of Central & West Africa.
9. Schistosoma Haematobium:
- Causes urogenital Schistosomiasis.
- It is scattered throughout Africa, parts of Arabia,
the Near East, Madagascar and Mauritius.
Schistosoma Mansoni:
- Is mainly found in Africa & Madagascar.
- It was exported by the slave trade to parts of South
America, the Caribbean & Arabia, where permissive
snail intermediate hosts were present.
10. First discovered in JAPAN, Nowadays is found
in China, the Philippines & Sulawesi.
There’s also a small focus in the Mekong river on
the east border of Thailand caused by Schistosoma
Mekongi.
Schistosoma Mansoni & S. japonicum
cause disease of the bowel & liver.
Schistosoma Intercalatum.
11. Adult worms in humans reside in the mesenteric venules
in various locations, which are specific for each species:
S. Japonicum is more often in small intestine.
S. Mansoni occurs more often in the superior
mesenteric veins draining the large intestine.
S.Haematobium most often occurs in the venous plexus
of bladder & uterus, but it can also be found in the rectal
venules.
12. S.Intercalatum: which found in urine & it’s
related to S.Haematobium.
S.Bovis: which infects cattle.
S.Makongi: similar to S.japonicum.
13.
14. Adult schistosomes are white
greyish worms.
( 6 – 28 ) mm long & in breadth
of ( 0.25 – 1 ) mm.
Schistosomes have separate
sexes ( male & female ).
Both have an oral sucker
opening into the alimentary tract,
& a posteriorly situated sucker.
15. Flat in shape.
It has a large ventral groove
( gynaecophoric canal ), encloses
the female during pairing.
The digestive system consists of
short esophagus opening into an
intestine.
The male reproductive system
comprises 4 or 5 pairs of testes.
16. Cylindrical in shape.
More longer, slender &
much darker color than
male.
The digestive system is
similar to that of male.
The reproductive system
consist of a pear shaped
ovary in the mid body line.
21. Stages of life cycle & their time frames:
(1) Cercarial invasion & Schistosomular migration.
(2) Maturation of schistosomes, pairing
& commencement of egg-laying.
(3) Established infection with continuous egg-laying.
(4) Late stages & complications.
22. The clinical complement
of cercarial dermal invasion
is a schistosome ( cercarial
or allergic ) dermatitis
lasting for 24 - 48 hours.
The pathophysiological
response is the initiation
of the 1st mechanisms of the immune response
with marked eosinophilia & an antibody-dependent
cell mediated cytotoxic response involving IgG.
23. After 2 to 16 weeks after cercarial invasion,
during the migration of schistosomulae, their
maturation, pairing & initiation of egg-laying,
the clinical manifestations of acute toxemic
Schistosomiasis ( katayama syndrome ) may arise.
Worm or egg antigens produce a marked antigenic
stimulus with rapidly rising antibody levels & an
increase in serum IgG, IgA & IgM levels.
24. Then circulating antigen antibody complexes are
found & may be deposited in glomeruli, producing
immune complex glomerulopathy.
The whole clinical picture is one resembling
the acute serum sickness syndrome.
From 2 months onwards the stage of established
infection occurs, with continuous egg-laying
associated with the classical symptoms &
signs of established Schistosomiasis.
25. SEAs from miracidia in the eggs provoke a T
lymphocyte-mediated host response which
in time result in the characteristic granuloma
with eosinophils prominent in the destruction
of the eggs.
After some years, change in clinical symptoms
& physical sign appear, & there is superimposi-
tion of late stage complication such as:
Obstructive Uropathy, Hydronephrosis
& Pyelonephritic renal failure.
26. Overtime T suppressor lymphocyte & antibody
blockade diminish the host immune response
fibroblasts stimulate collagen production and
fibrotic complications involving a variety of
anatomical sites will developed ( e.g. periportal
hepatic fibrosis and obstructive Uropathy ).
27. Acute Schistosomiasis
It is a systemic hypersensitivity reaction against the
migrating schistosomulae and/or the onset of egg
production, occurring within a few weeks to months
after a primary infection.
The onset is sudden, with:
- Fever & Myalgia.
- Fatigue & Malaise.
- Nonproductive cough.
- Elevated IgE.
- Patchy infiltrates on chest X-Ray.
28. Most patients recover spontaneously after 2-10
weeks but some develop a persistent & serious
illness with:
Weight loss.
Dyspnea.
Diarrhea.
Diffuse abdominal pain.
Toxemia.
Hepatosplenomegaly.
Generalized rash.
Intense infections are occasionally fatal.
29. Katayama fever caused by S.japonicum infections can
present as serious & sometimes fatal, serum sickness-
like disease which possibly results from the early
release of large quantities of egg antigens that cross-
reacts with antibodies to schistosomulae, resulting in
immune complexes that cause hypertrophy of lymph
reticular tissue characterized by:
Fever.
Hepatosplenomegaly.
Cachexia.
Which may evolve directly to severe hepatosplenic
fibrosis & portal hypertension.
30. Chronic Schistosomiasis:
It is largely associated with the granulomatous
& fibrotic responses to Schistosoma ova during
mature infections and mainly include:
A- Urinary Schistosomiasis.
B- Intestinal Schistosomiasis.
31. Urinary Schistosomiasis:
The eggs of S. haematobium provoke granulomatous
inflammation, ulceration and pseudopolyposis of the
mucosa & sub mucosa of the bladder and the ureters
Common early symptoms include Dysuria, Urinary
frequency & urgency, Terminal hematuria.
In endemic areas ( Terminal hematuria ) is the “red
flag of Schistosomiasis” in children between the age
of 5 and 10 years old.
32. Chronic infection may lead to:
- Obstructive Uropathy.
- Renal failure.
- Bladder cancer ( SCC ).
Intestinal Schistosomiasis:
The eggs of S. Mansoni, S. japonicum & other species
migrate through the intestinal wall where they provoke
mucosal granulomatous inflammation, pseudopolyposis,
micro-ulcerations & superficial bleeding.
Most lesions are situated in the large bowel
& the rectum.. small bowel pathology is rare.
33.
34. The human immune response in
Schistosomiasis is primarily due to
antibody-dependent cell-
mediated cytotoxicity.
So based on the mixture of preformed
circulating antibodies, cytokines & the
responsiveness of lymphoid cells in
the peripheral blood.
35. 4 to 6 weeks after a primary infection, schistosome-
specific immunoglobulin is produced that, together
with complement, eosinophils, macrophages,
platelets & mast cells is able to
form complexes & attack
schistosomules.
Acute Schistosomiasis:
It occurs in individuals who
have no previous history of
exposure & become infected
after travelling into an endemic area.
36. There is a remarkable level of peripheral-
blood mononuclear cells (PBMCs) produce large
quantities of tumor-necrosis factor (TNF),
interleukin-1 (IL-1) and IL-6, reflects a dominant
T helper 1 (TH1), rather than TH2 response.
37. There was a correlation
between elevated levels
of nitric oxide ( NO ) &
disease severity, which
indicates that a combination
of reactive oxygen & nitrogen
intermediates might have a
role in acute disease.
38. TH2 responses seem to have
a crucial role in modulating
potentially fibrosis life-
threatening chronic disease.
The main TH2 cytokine that
is responsible for fibrosis
is IL-13.
Chronic Schistosomiasis:
39. It has been recognized that the egg stage of
the schistosome is responsible for inducing
the TH2 response.
TH2 induces CD4+ T-cell response that
initiates the development of granulomatous
lesions, which are composed of collagen fibers
& cells, including macrophages, eosinophils
& CD4+ T cells around the individual eggs.
49. Laboratory Diagnosis & Imaging
Samples:
- Stool.
- Urine.
- Serum.
Macroscopic:
- Stool speciment ( may be dysenteric ).
- Urine speciment ( may be terminal hematuria ).
50. Microscopically:
1- Demonstration of parasite eggs in stool or urine is
gold standard test for diagnosing Schistosomiasis.
2- The sensitivity my be low especially with light
infection & take 6 weeks for eggs to be detect
after the initial infection.
3- S.Haematobium eggs are usually found in urine
but my also be present in stool.
4- S.Mansoni & the other intestinal schistosomes,
S.japonicum, S.Merangi & S.Intercalatum are
found in stool.
53. Full blood count:
1- May show an eosinophilia which is frequently
marked during the acute stage of infection.
2- Anemia patient may also be seen due to chronic
blood loss from the urinary or intestinal tract.
3- Pation with hepatosplenic Schistosomiasis my have
thrombocytopenia secondary to splenic sequestration.
Diagnosis can also be made by demonstrating eggs in
tissue biopsy specimens from the rectum, liver, bladder
or cervix depending on the site of infection.
54. Antigen detection:
Schistosoma the antigen weaks are present in
the serum & urine.
To antigen referred to as circulating anodic antigens
(CCA) & circulating cathodic antigens ( CCA ) can be
detected in laboratory sensitivity of these test
depend on largely & intensity of infection.
Antibody test:
Schistosoma antibodies can be detected by enzyme
linked lmmunosorbent assay ( ELISA ).
it is application is limited as these antibodies
will only appear after 4-6 weeks.
present of IgE antibody is marked of chronic active
disease.
55. Polymerase chain reaction PCR:
Specific & highly sensitive detection of Schistosoma.
DNA in urine, stool & serum.
Advantage able to diagnosis Schistosomiasis in all
stage of infection.
56. ( For S.Haematobium )
look for signs of hematuria, Dysuria, & Eosinophilia.
These should be enough to suggest a diagnosis
for those living in endemic regions.
A plain X-ray for the abdomen may show
the calcification of the urinary bladder.
An I.V.P should be done to determine the extent
of the disease in the kidneys & ureters.
The changes in the urinary system are usually
reversible on treatment.
57. Fatigue.
Abdominal pain even without dysenteric symptoms
in endemic regions should suggest a diagnosis.
Dysenteric symptoms.
A chest x-ray is indicated in a patient who comes in
with signs of pulmonary hypertension ( mottling of
the lungs is seen ).
( For S.Mansoni )
58. A Barium meal or endoscopy is used to detect any
varices.
A liver biopsy is indicated to show periportal fibrosis.
splenic-venoprtography may be done to outline the
portal system.
59.
60. Praziquantel affective against
all adult schistosome species
& it has no side effects.
In the treatment of a
patient of S. Haematobium or
S. Mansoni or S. Intercalatum
a single oral dose ( 40 mg/kg ).
But the S.japonicum total dose
is ( 60 mg/kg ), Best given after
food.
Cure rate is 80% !!
With acute infection
corticosteroids may
..
be given
61. Oxamniquine Only against S.Mansoni.
- High cure rates ( 60 - 90% ).
Side effects: dizziness, drowsiness, headache.
- Should not be given during the first 4 months
of pregnancy.
Metrifonate against S.Haematobium.
- Artemisinin.
- Hycanthone ( Etrenol ).
- Niridazole ( Ambilhar ).
- Lucanthone ( Mirasil D ).
Other
Drugs
62. Complications:
1- pulmonary Schistosomiasis:
Chronic S.Mansoni causing obliterative arteries
which lead to :
- Pulmonary hypertension.
- Increase right heart pressure.
- Right arterial dilatation.
- Right ventricular hypertrophy.
2- Glomerularnephritis:
Due to deposition of immune complex in the renal
glomeruli. May be asymptomatic or manifested as
nephrotic syndrome.
63. 3- Genital:
- In female lead to infertility.
- In male causing hemospermia.
4- Neuroschistosomisis:
S.Haematobium & S.Mansoni caused spinal
cord & transverse myelitis.
Others:
- Paraplegia.
- Pain or loss of sensation.
- Skin rash.
- Personality change.
- Confusion.
64. Complication of Schistosomiasis in GIT :
Gastrointestinal bleeding this case in patient with
nonvariseal upper gastrointestinal bleeding induced
by gastric & duodenal involvement of Schistosoma
Mansoni which unique case sever & recurrent upper
gastrointestinal bleeding was induced by central
ulceration of gastric pseudopolypoid & duodenal
polypoid lesions.
65. • portal hypertension as complication are due to
mechanical obstructive pathology resulting from
periportal fibrosis where eggs are still found.
• Hepatitis due to chronic S.Mansoni infected patient
co infected with hepatitis B or C are prone to have
clinically more sever infection prior parenteral
treatment for Schistosomiasis my also have
substantially increased risk for hepatitis.
66. Complication of Schistosomiasis in pregnancy:
1- Associate with anemia and low birth weight.
2- High risk of ectopic pregnancy.
3- Pregnancy complication from uvular or fallopian
granuloma.
Schistosomiasis-associated Bladder Cancer:
Bladder cancer diagnosis & mortality are elevated in
affected area. Risk of bladder cancer appear to be high
in smokers due to chronic irritation of bladder lining
allowing it to be exposed to carcinogens from smoking.
67. Bleeding form esophageal varices
may be treated systematically with
β-blockers, endoscopy, Splenectomy,
or porta caval shaunts.
In advanced urinary Schistosomiasis
destructed & Non-functional kidneys
may have be removed.
68. Topical steroid & oral antihistamines can
provide symptomatic relief for adversarial
dermatitis.
katayama fever is primarily treated with
corticosteroids, for example: Prednisolone
40 mg daily, for 5-14 days, to suppress the
hypersensitivity reaction.
The treatment should be followed be
Praziquantel to eliminate the adult worms.
69. Neuro anastomosis requires specialized
care, again with corticosteroids and if
necessary anticonvulsants prior to
Praziquantel treatment.
71. Mass Drug Administration aims to:
1- Reducing morbidity & mortality rate due to the infection.
2- Prevent new infection by limiting transmission through
reduction of the overall prevalence in the population.
3- Reduction in excretion of schistosome eggs.
The administration
of drugs to whole
populations
irrespective
of disease status is
referred to as Mass
Drug Administration
( ).
72. Prevention:
1- Early diagnosis &Treatment.
2- Snails Control.
3- Health Education & Community Participation.
4- Water Supply & Environmental Sanitation.
5- Capacity building.
Control:
Is dominated by chemotherapy & molluscicides.