SCHISTOSOMIASIS

Introduction
This is a slow, progressive disease caused by blood flukes of the
class Trematoda. It is a chronic wasting disease common among
farmers and their families in certain parts of the world.
Affects many in developing countries (its estimated that 207M
have the disease and that of those, 120M are symptomatic).
Etiologic agents:
1. Schistosoma japonicum

This agent infects the intestinal tract (Katayama

disease).

Found to be the only type that is endemic in the

Philippines.

Oriental Schistosomiasis

S. japonicum eggs small and almost spherical with tiny spine.

2. Schistosoma mansoni

It also affects the intestinal tract .

Most common in parts of Africa.

S. mansoni eggs have a spike on the side

(spine).
3. Schistosoma haematobium

Affects the urinary tract.

Can be found in some parts of the Middle

East, like Iraq and Iran.

S. haematobium eggs are oval and have a

spike at the tip.

Incubation period
Incubation period is at least 2 months.
Source of Infection:
1. Feces of infected person.
2. Dogs, pigs, carabaos, cows, monkeys and wild rats have been found to
be infected and therefore, also serve as hosts.
Mode of transmission
The disease is transmitted through:
1. ingestion of contaminated water.
2. Penetration through skin pores.
3. Intermediate host- Tiny snail called the Oncomelania quadrasi.

Characteristics of Oncomelania quadrasi

The snail thrives best along riverbanks, fresh water streams, creeks, canals
and swamps.
It can be found clinging to water hyacinths, grasses, decaying leaves and
pieces of rotting wood, bamboo and coconut husks
The adult snail is greenish-brown in color and is just as big as the smallest
grain of a palay.
PATHOGENESIS
The larvae (cercariae) penetrates the skin or mucuous membranes and
eventually work their way to the livers venous portal circulation.
In the portal vessels, they mature within 1 to 3 months.
The mature worms live in the copula in the portal vessels and migrate to the
other parts of the body.
The female cercaria lays eggs in the blood vessels surrounding the large
intestines or bladder.
Ulceration in the mucosa occurs and the eggs are able to escape into the
lumen of the large intestine and are excreted with feces.
Some of the eggs are carried by the portal circulation and filtered in the liver
where small lesions or granulomas are formed.
These granulomas are resolved and are replaced by fibrous tissue.
Likewise, the ulcerations in the intestines are healed and scar formation
occurs.
As the disease progresses, the liver enlarges due to increasing fibrosis.
The flow of blood is interrupted in the intrahepatic portion, thereby resulting
in portal hypertension.
Fluid accumulates in the patients bely, making it bulge (Ascites).
Pathology
Colon: acute -mucosa congestion,
edema and egg granuloma
chronic-fibro obstructive lesion
Liver: acute -enlargement of the liver
and egg granuloma on it
chronic-portal liver cirrhosis .
Clinical Manifestations
The signs and symptoms of the disease will depend on the site of infection
however the following can be observed:

 1. A pruritic rash known as the swimmers itch develops at the site of

penetration.
2. Low grade fever, myalgia and cough.
3. There is abdominal discomfort due to hepatomegaly, splenomegaly and
lymphadenopathy.
4. There are bloody-mucoid stools, similar to those in dysentery, that comes
on and off for weeks.
5. Patient becomes icteric and jaundiced.
6.Later, the patients belly becomes big because of an inflamed liver,
resulting from the accumulation of eggs in the organ.
7.Patient becomes weak, pale and there is marked muscle wasting.
8. When the parasites reach the brain, there will be severe headache,
dizziness and convulsions
Acute Schistosomiasis
Clinical manifestations come out after 4 to 8 weeks of infection, similar to the
time from egg to adult worm (40 days)

Fever: intermittent, maintain weeks to months

Allergic reaction:urticaria, angioneuroedema, enlargement of lymph nodes

and eosinophilia
Digestive syndromes: abdominal pain, diarrhea with pus and blood,
constipation or diarrhea
Hepatosplenomegaly
Chronic Schistosomiasis
Asymptomatic: most person are asymptomatic
Symptomatic: the most common syndrome is abdominal pain with
intermittent diarrhea.
hepatosplenomegaly
COMPLICATIONS
1. Liver Cirrhosis & Portal HPN
2. Cor pulmonale & Pulmonary HPN
3. Heart failure
4.Ascites
5.Hematemesis- from REV
6. Renal failure
7. Cerebral schistosomiasis

 Cerebral schistosomiasis is caused by the hosts reaction to schistosoma

eggs, The mechanism of egg deposition is unknown, but the presnce of the
eggs suggests that they may cross the BBB or that some worm pairs may
reach the venous side of the cerebral circulation.
Diagnostics
1. Fecalysis or Direct stool exam
2. Kato-Katz technique
3. Liver and rectal biopsy
4. ELISA
5. Circumoval precepitin test (COPT)
Treatment
Treatment
Praziquantel is the best choice of drug for the therapy of
schistosomiasis
Dose:
1 tab 2x a day for three months then 1 tab a day for another 3
months.
Fuadin injection given either IM or IV. The patient should consume 360mg
for the entire treatment.
Prevention
To prevent schistosomiasis, one must have through knowledge of how the
disease spreads. The basic principle of its prevention and control is
interrupting the life cycle of the worm and protecting people from the
infection. This can be achieved through the following measures:
1. Have a stool examination.
2. Reduce snail density by:

A. clearing vegetation, thus exposing the snails to sunshine.

B. constructing a drainage system (canals) to dry the areas where the

snails thrive.

C. Improve farming through the proper irrigation and drainage, crop

rotation and removal of weeds thus disturbing the living condition of
the snail.

3. Diminish infection rate through:

A. Proper waste disposal

B. Control of stray animals

C. Prohibition of people especialy children from bathing in infested

streams.

D. Construction of footbridges over small infested streams

E. provision of an adequate water supply for bathing and laundering

and safe water for drinking.

4. Providing health education on the disease process, mode of transmission and

prevention.
Common Nursing Diagnosis
Risk for Infection and Bleeding
Impaired skin integrity
Altered urinary elimination
Body image disturbance
Altered role function
Knowledge deficit