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Background
- Caused by parasitic trematodes of the species Schistosoma
- Reservoir is freshwater snails
- Endemic in areas of Africa and Southern Asia
- The Cercariae (the stage of trematode released by the snail) can infect by direct penetration through the skin
- Infects >200million people worldwide with 10% suffering severe consequences
DDx
Diagnosis
- Mostly a chronic condition
- Second most common cause of esophageal varicies worldwide
- Greatly elevated bladder cancer rates in endemic areas
- Can cause renal failure, liver failure, pulmonary hyptertension, GI bleeds and rarely CNS symptoms
- Mostly through fibrosis of affected organs
- Genitourinary schistosomiasis
- Caused by sores in the genital tract
- May persist even after treatment
- Greatly increases risk of HIV infection
- Acute presentations
- Cutaneous rash/itching from cercariae penetration (immediate)
- Katayama fever-Fever, Abdominal pain, Fatigue, Cough, Diarrhea, Eosinophilia (lasts 4-8 weeks)
- Diagnosis
- ELISA
- PCR from stool or urine
- Stool and Urine for ova/parasites
- biopsy may be needed for those who do not show ova/parasites in stool/urine
- CBC, Alk Phos, GGT, ALT/AST, Cr, Blood Cx
- Consider US for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
- Echo and CXR for pulmonary HTN and/or cor pulmonale
- Consider CT or MRI for CNS disease or further w/u of periportal fibrosis
Treatment
- Praziquantel 20mg/kg PO for two doses in 1 day
- S.japnonicum requires 3 doses in 1 day
Sources
- Wikipedia
- CDC.gov/parasites/schistosomiasis
- Uptodate
- Tintinalli
- Colley DG, Bustinduy AL, Secor WE, King CH. Human Schistosomiasis. Lancet. 2014 Jun 28;383(9936):2253-64.