Schistosomiasis

Definition
Schistosomiasis is a parasitic disease caused by blood flukes (trematodes) of the
genus Schistosoma.1
Epidemiology
Today, 120 million people are symptomatic with schistosomiasis, with 20 million having severe
clinical disease. More than 200,000 deaths per year are due to schistosomiasis in sub-Saharan
Africa. Women washing clothes in infested water are at risk. Hygiene and playing in mud and
water make children vulnerable to infection. Forty million women of childbearing age are
infected. Approximately 10 million women in Africa have schistosomiasis during pregnancy. In
endemic areas, the infection is usually acquired as a child.
The intensity and prevalence of infection then rises with age and peaks usually between 15 to 20
years. In older adults, no significant change is found in the prevalence of disease, but the parasite
burden or the intensity decreases. Worldwide, 1 in every 30 individuals
has Schistosomainfection.1
Sex
Schistosomiasis is more common in males, most likely because of increased exposure to infected
water via bathing, swimming, and agricultural activities.
Age

Exposure to infection can start shortly after birth.

People aged 10-14 years are at the maximum risk of exposure.
The lower prevalence in adults is possibly due to partial immunity and decreased
exposure to infected water.1

Etiology
Parasites of the genus Schistosoma (S. mansoni, S. mekongi, S. intercalatum, S. hematobium,
and S. japonicum) cause the disease.2
Pathomechanism
Human beings become infected when larval forms of the parasite, released by freshwater snails,
penetrate their skin during contact with infested water. In the body, the larvae develop into adult
schistosomes. Adult worms live in the blood vessels, where the females release eggs. Some of
the eggs are passed out of the body in the feces or urine to continue the parasite life-cycle. Others
become trapped in body tissues, causing an immune reaction and progressive damage to organs.1
Cercaria
Cercaria

allergic dermatitis

pruritic papular rash

Schistosomula
These are tailless cercariae that are transported through blood or lymphatics to the right side of
the heart and lungs. Heavy infection can cause symptoms such as cough and fever. Eosinophilia
may be observed.
Eggs
Katayama fever
occurs 4-6 weeks after infection
immune complex formation
high worm and egg antigen stimuli
lead to a serum sicknesslike illness
Schistosomiasis
It is due to immunological reactions to Schistosoma eggs trapped in tissues. Antigens released
from the egg stimulate a granulomatous reaction comprised of T cells, macrophages, and
eosinophils that results in clinical disease. In the latter stages of the disease, the pathology is
associated with collagen deposition and fibrosis, resulting in organ damage that may be only
partially reversible.
Eggs can end up in the skin, brain, muscle, adrenal glands, and eyes. As the eggs penetrate the
urinary system, they can find their way to the female genital region and form granulomas in the
uterus, fallopian tube, and ovaries. CNS involvement occurs because of embolization of eggs
from the portal mesenteric system to the brain and spinal cord via the paravertebral venous
plexus.1

Clinical Features

Acute schistosomiasis
o Generalized lymphadenopathy

o Hepatosplenomegaly
o Rash
o Fever

Chronic schistosomiasis
o Portal hypertension with abdominal distention, hepatosplenomegaly, pedal edema,
pallor, distended abdominal veins, and ascites
o Intestinal polyposis with heme-positive stool, pallor, and signs of malnutrition
o CNS symptoms, including focal neurological findings, seizures, and spinal cord
lesions
o Renal failure with anemia and hypertension
o Cor pulmonale with signs of right heart failure
o S mansoni, S mekongi, S intercalatum, and S japonicum cause intestinal tract and
liver disease.
o S hematobium only rarely causes intestinal or liver disease but characteristically
causes urinary tract disease.
o Genital lesions, including ulceration, hypertrophic, or nodular lesions of the
cervix, vulva, or vagina or vesicovaginal fistula3

Diagnosis
Stool or urine analysis

Identify and speciate the eggs in the stool or urine.

Urinary excretion of eggs is not uniform. The urine is most likely to be positive for S
hematobium from 10 am until 2 pm.

Quantification of the egg excretion is calculated by collecting 24-hour urine or stool,

homogenizing the sample, and counting the eggs in a measured sample.

Urine or stool egg count in a 24-hour collection quantitates the severity of the
infection.

Fewer than 100 eggs per gram of stool or 10 ml of urine indicates a light infection;
100-400 eggs per gram of stool or 10 ml of urine indicates a moderate infection, and
more than 400 eggs per gram of stool or 10 ml of urine indicates a heavy infection.

Determination of the intensity of infection is an important tool in endemic areas, as

many of the complications of schistosomiasis are related to the parasite burden. This is
performed by quantitative sampling of 20-50 g of stool (Kato-Katz technique) or a
standardized volume of urine through a Nuclepore membrane.
Egg viability test
An active infection produces viable eggs, while treated or past infection results in nonviable eggs
and an absence of miracidia.

Requires mixing the stools or urine with room-temperature distilled water and observing for
hatching miracidia.
Acute illness is often associated with eosinophilia in the blood and tissues.
With chronic illness, peripheral eosinophilia may be minimal or absent while tissue eosinophilia
persists.
Serology
FAST, ELISA, Immunoblot assays4
Management

Praziquantel : treat all forms of Schistosomiasis

Oxamniquine : treat intestinal schistosomiasis

Metrifonate : effective for the treatment of urinary schistosomiasis

Controlling

health education
the supply of drinking water and the planning of adequate healthcare facilities

diagnosis and treatment

management of the environment

control of the intermediate hosts (freshwater snails)5

Complication

Liver damage
Intestine damage
Lung damage
Bladder damage
Bladder stones
Bladder cancer
Cirrhosis of the liver6

Prognosis
With treatment prognosis is good
Reference
1.

Ahmed, Shadab Hussain. Schistosomiasis. 2010. Available from:

http://emedicine.medscape.com/article/228392-overview#showall

2.

Anonymous. Schistosomiasis. Available from:

http://www.medicinenet.com/schistosomiasis/article.htm

3.

Ahmed, Shadab Hussain. Schistosomiasis Clinical Presentation. 2010. Available from:

http://emedicine.medscape.com/article/228392-clinical#showall

4.

Ahmed, Shadab Hussain. Schistosomiasis Workup. 2010. Available from:

http://emedicine.medscape.com/article/228392-workup

5.

MicrobiologyBytes. Schistosomiasis. 2007. Available from:

http://www.microbiologybytes.com/introduction/Schisto.html

6.

Anonymous. Complication of Schistosomiasis. 2011. Available from:

http://www.wrongdiagnosis.com/s/schistosomiasis/complic.htm