Schistosomiasis , also known as bilharzia, malaria in terms of socio-economic and public health

bilharziosis or snail fever, is a parasitic disease
caused by several species of trematodes (platyhelminth
infection, or "flukes" for examples, S. hematobium, S.
mansoni, S. japonicum S.intercalatum, and S.
mekongi,), a parasitic worm of the genus Schistosoma.
Although, schistosomiasis has a low mortality rate, it
is often a chronic illness that can damage internal
organs like the liver causing hepatic granulomas and
fibrosis in children, and also causes impair growth and
cognitive development. The urinary form of
schistosomiasis is associated with increased risks for
bladder cancer in adults which is caused by S.
hematobium. Schistosomiasis is the second most
socioeconomically devastating parasitic disease after
malaria.
importance in tropical and subtropical areas.
According to World Health Organisation{WHO},
Schistosomiais is prevalent in tropical and sub-tropical
areas, especially in poor communities without access
to safe drinking water and adequate sanitation. Of the
200 - 207 million people with schistosomiasis in the
World, 85% live in Africa, while 280,000 die annually
globally.
As mentioned above, there are two major forms of
schistosomiasis – intestinal and urogenital – caused by
five main species of blood fluke, the table below
shows different species with their geographical
distribution.

There are two types of schistosomiasis,

Parasite species and geographical distribution of
Intestinal Schistosomiasis :is caused by Schistosoma schistosomiasis
mansoni ,Schistosoma intercalatum , Schistosoma
mekongi and, Schistosoma japonicum, but S.
japonicum and S. menkogi are specifically associated
Africa, the
with Asian intestinal schistosomiasis.
Middle East, the
Intestinal Schistosoma
Caribbean, Brazil,
Urogenital Schistosomiasis: caused by Schistosoma schistosomiasis mansoni
Venezuela,
haematobium.
Suriname
There are other species of Schistosoma that can infect Schistosoma China, Indonesia,
other animals: japonicum the Philippines
Several districts
S. bovis — normally infects cattle, sheep and goats in Schistosoma
of Cambodia and
Africa, parts of Southern Europe and the Middle East the Lao People’s
mekongi
S. mattheei — normally infects cattle, sheep and goats Democratic
in Central and Southern Africa Republic
S. margrebowiei — normally infects antelope, buffalo Schistosoma
and waterbuck in Southern and Central Africa intercalatum and Rain forest areas
S. curassoni — normally infects domestic ruminants in related S. of central Africa
West Africa guineansis
S. rodhaini — normally infects rodents and carnivores Urogenital Schistosoma Africa, the
in parts of Central Africa schistosomiasis haematobium Middle East
Schistosomiasis particularly affects agricultural and
EPIDEMIOLOGY
fishing populations. Women doing domestic chores in
infested water, such as washing clothes, are also at
The disease is found in tropical countries in Africa, the
risk. Hygiene and play habits make children especially
Caribbean, eastern South America, Southeast Asia and
vulnerable to infection.
in the Middle East. Schistosoma mansoni is found in
parts of South America and the Caribbean, Africa, and
In north-east Brazil and Africa, refugee movements
the Middle East; S. haematobium in Africa and the
and migration to urban areas are introducing the
Middle East; and S. japonicum in the Far East. S.
disease to new areas. Increasing population size and
mekongi and S. intercalatum are found locally in
the corresponding needs for power and water, often
Southeast Asia and central West Africa, respectively.
result in development schemes and environmental
modifications that also lead to increased transmission.
Among human parasitic diseases, schistosomiasis
(sometimes called bilharziasis) ranks second behind
With the rise in eco-tourism and travel “off the beaten
track”, increasing numbers of tourists are contracting
schistosomiasis. At times, tourists present with severe
acute infection and unusual problems including
paralysis.
Urogenital schistosomiasis is also considered to be a
risk factor for HIV infection, especially in women.
Schistosomiasis is endemic in Nigeria as revealed by
several prevalence studies but the degree of
endemicity is low. The proliferation of several
irrigation projects all over the country has stabilized
the infection in Northern Nigeria while in the West
rapid urbanisation, supply of portable water and mass
chemotherapy have combined to reduce the prevalence
rates. Human infection is measured by the
determination of incidence, prevalence and intensity of
infection. The prevalence of severe pathological forms
of the disease is very low and schistosomiasis is not
associated with bacteriuria or hypertension in Nigeria,
although isolated cases of ectopic lesions of the
genitalis and uterus have been reported. Nodular filling
defects occur early during infection, while bladder
calcification comes at a later stage. The severity of the
disease is related to the intensity of infection.
Urinary schistosomiasis is endemic in Nigeria in
general. Although there is no current estimate of the
disease in the country, past estimates have put the
infection at about 25 million people and 101 million at
risk of infection respectively. In Ogun State, urinary
schistosomiasis has been reported in several
communities. However, these studies were based on
school-aged children and adults with little or no
information on pre-school children.
In Ogun State, Four hundred and fifty respondents
were examined for urinary schistosomiasis in Ibaro-
Oyan and Abule Titun communities that depend on the
Oyan Dam for their livelihood. Using laboratory
examination of urine samples and structured
questionnaire, prevalence was 86.0% Ibaro-Oyan and
88.0% Abule-Titun. Males were more infected (89%
Ibaro-Oyan and 96% Abule Titun) than females (82%
and 74% respectively). Statistical analysis showed no
significant difference in infection rates between sexes
(p>0.005). Sixty-seven per cent males and 53%
females in Ibaro-Oyan and 64% males and 53%
females in Abule Titun had observable haematuria in
their urine. Most respondents (97.4% and 99.6%) from
Ibaro-Oyan and Abule Titun rely heavily on the Oyan
Dam for source of water and also aware that infection
is due to their water contact activities with the dam.
The continued high endemicity could be reduced if the
Ogun State government incorporates the political will
to eliminate the scourge.
Clinical Manifestation
Schistosomiasis is a chronic disease. Many infections
are subclinically symptomatic, with mild anemia and
malnutrition being common in endemic areas. Acute
schistosomiasis (Katayama's fever) may occur weeks
after the initial infection, especially by S. mansoni and
S. japonicum. Manifestations include:
 Abdominal pain
 Cough
 Diarrhea
 Eosinophilia — extremely high eosinophil
granulocyte (white blood cell) count.
 Fever
 Fatigue
 Hepatosplenomegaly — the enlargement of
both the liver and the spleen.
 Genital sores — lesions that increase
vulnerability to HIV infection. Lesions caused
by schistosomiasis may continue to be a
problem after control of the schistosomiasis
infection itself. Early treatment, especially of
children, which is relatively inexpensive,
prevents formation of the sores.[2][3]
 Skin symptoms: At the start of infection, mild
itching and a papular dermatitis of the feet and
other parts after swimming in polluted streams
containing cercariae.[4]:432
Occasionally central nervous system lesions occur:
cerebral granulomatous disease may be caused by
ectopic S. japonicum eggs in the brain, and
granulomatous lesions around ectopic eggs in the
spinal cord from S. mansoni and S. haematobium
infections may result in a transverse myelitis with
flaccid paraplegia.
Continuing infection may cause granulomatous
reactions and fibrosis in the affected organs, which
may result in manifestations that include:
 Colonic polyposis with bloody diarrhea
(Schistosoma mansoni mostly);
 Portal hypertension with hematemesis and
splenomegaly (S. mansoni, S. japonicum);
 Cystitis and ureteritis (S. haematobium) with
hematuria, which can progress to bladder
cancer;
 Pulmonary hypertension (S. mansoni, S.
japonicum, more rarely S. haematobium);
 Glomerulonephritis; and central nervous
system lesions.
Bladder cancer diagnosis and mortality are generally
elevated in affected areas.
Possible Complications
 Bladder cancer
 Chronic kidney failure
 Chronic liver damage and an enlarged spleen
 Colon (large intestine) inflammation with
bloody diarrhea
 Kidney and bladder obstruction
 Pulmonary hypertension
 Repeated blood infections can occur, because
bacteria can enter the bloodstream through an
irritated colon
 Right-sided heart failure
 Seizures
Diagnosis
. Schistosomiasis is diagnosed through the detection of
parasite eggs in stool or urine specimens.
. For urogenital schistosomiasis, a filtration technique
using nylon, paper or polycarbonate filters is the
standard. Children with S. haematobium almost always
have microscopic blood in their urine and this can be
detected by chemical reagent strips. Asking children
about a history of blood in their urine can also be used
to identify communities at high risk of infection,
therefore assisting in mapping priority areas for
intervention.
. The eggs of intestinal schistosomiasis can be
detected in faecal specimens through a technique using
methylene blue-stained cellophane soaked in glycerine
or glass slides.
. For people from non-endemic or low transmission
areas, serological and immunological techniques may
be useful in the detection of infection.
Treatment
This infection is usually treated with the drug
Praziquantel. If the infection is severe or involves the
brain, corticosteroids may be given. The World Health
Organization has developed guidelines for community
treatment of schistosomiasis based on the impact the
disease has on children in endemic villages
 When a village reports more than 50 percent of
children have blood in their urine, everyone in
the village receives treatment.
 When 20 to 50 percent of children have bloody
urine, only school-age children are treated.
 When less than 20 percent of children have
symptoms, mass treatment is not implemented
 Praziquantel is the only available treatment
against all forms of schistosomiasis. It is
effective, safe and low-cost. Even though re-
infection may occur after treatment, the risk of
developing severe disease is diminished and
even reversed when treatment is initiated in
childhood.
 Praziquantel has been used successfully over
the past 20 years to control schistosomiasis in
Brazil, Cambodia, China, Egypt, Morocco and
Saudi Arabia.
 Outside of the U.S., there is a drug available
exclusively for treating Schistosoma mansoni
(oxamniquine) and one exclusively for treating
S.hematobium (metrifonate).
Outlook (Prognosis)
Treatment before significant damage or severe
complications occur usually produces good results
Prevention and control
Prevention and control of schistosomiasis is based on
preventive treatment, snail control, improved
sanitation and health education.
The WHO strategy for schistosomiasis control focuses
on reducing disease through periodic, targeted
treatment with praziquantel. This involves regular
treatment of all people in at-risk groups.
Groups targeted for treatment are:
school-aged children in endemic areas;
 adults considered to be at risk in endemic
areas, e.g. pregnant and breastfeeding women,
people with occupations involving contact with
infested water – such as fishermen, farmers,
irrigation workers – and women whose
domestic tasks bring them into contact with
infested water;
 Entire communities living in endemic areas.
Avoid swimming or bathing in contaminated or
potentially contaminated water
 Avoid bodies of water of unknown safety
 Snails are an intermediate host for the parasite.
Getting rid of snails in bodies of water used by
humans would help prevent infection.
The frequency of treatment is determined by the
prevalence of infection or visible haematuria (in the
case of urogenital schistosomiasis) in school-age
children. In high transmission areas, treatment may
have to be repeated every year for several years.
The aim is to reduce disease: periodic treatment of at-
risk populations will cure mild symptoms and prevent
infected people from developing severe, late-stage
chronic disease. However, a major limitation to
schistosomiasis control is access to praziquantel.
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