Schistosomiasis

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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

Clinical Features

Acute

  • Cutaneous rash/itching from cercariae penetration (immediate)
  • Katayama fever-Fever, abdominal pain, Fatigue, Cough, Diarrhea, Eosinophilia (lasts 4-8 weeks)

Chronic (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 hypertension, 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

Differential Diagnosis

Evaluation

Work-up

  • 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 cultures
  • Consider ultrasound for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
  • Echo and CXR for pulmonary hypertension and/or cor pulmonale
  • Consider CT or MRI for CNS disease or further workup of periportal fibrosis

Management

  • Praziquantel 20mg/kg PO for two doses in 1 day [1]
    • S.japnonicum requires 3 doses in 1 day

Disposition

  • Generally may be discharged
  • Admit if concern for CNS infection

See Also

External Links

References

  1. CDC. Schistosomiasis. http://www.cdc.gov/parasites/schistosomiasis/health_professionals/index.html