Reporter: Ped C.

Silvestre

Introduction

Introduction Acute schitosomiasis:fever,enlargement and

around the portal vessels

tenderness of the liver,eosinophilia,and dysentery

Chronic schitosomiasis : fibro-obstructive lesion

Late stage: giant spleen, ascites, hypertension of

portal venous system

Three Major Factors

The method of disposal of human excreta The presence of the snail intermediate host

The contact with cercaria-infected

water

Oncomelania Quadrasi

s. s. m j

s. h

Poor sanitation

Endemic areas

Presence of snail
INTERMIDIATE HOST OF CECARIAE

Ingestion of contaminated water

Contact with cercaria-infected water

Increased susceptibility

Penetration of cercariae into the skin (3 days to reach the capillaries)

Schistosomule enters the bloodstream

(2-3wk old)Schistosomes matures in hepatic portal veins (LIVER)

(week5)Pair Schistosome migrates and lay eggs to other organs

INTESTINE (S. Japonicum and S. Mansoni)

BLADDER (S. Haematobium)

SCHISTOSOMIASIS

Liver Function Test: Acute stage: serum Blood Routine Test: Acute globulin rise, ALT slightly rise Chronic stage: most patients have a normal Stool Test : The discovery of eggs in stool is the evidence of diagnosis by direct smear or other methods Imaging test: B-ultrasound: the degree of liver cirrhosis CT: the image of liver and brain X-ray: chest; esophagus; and gastrointestinal tract

DRUGS:

Praziquantel is
the best choice of drug for the therapy of schistosomiasis.

stage :eosinophilia is
characteristic change.WBC raise to 10-30G/L Chronic stage:eosinophil slightly or moderate rise Terminal stage: WBC and platelets are lower

liver function,
especially asymptomatic Terminal stage: serum ALB descend caused

Oxamniquine

for S. mansoni Metrifonate for S. haematobium

by liver cirrhosis

Acute Schistosomiasis The history of contact with schistosome-infected

water. Schistosome dermatitis Incubation period: 23-73 days, average 1 month

Acute Schistosomiasis Clinical manifestations come out after 4 to 8 weeks time from egg to adult of infection, similar to the
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 are asymptomatic person

Symptomatic: the most common syndrome is abdominal pain with intermittent diarrhea. hepatosplenomegaly

Terminal stage of schistosomiasis

Liver cirrhosis is the prominent syndrome of this stage According to the manifestations , it can be divided into three types: The type of giant spleen The type of ascites The type of dwarf

Ectopic Lesion Schistosomiasis in lungs: by egg deposition. found in acute schistosomiasis,

Symptoms are light and signs are not clear

Schistosomiasis in brain:
Acute type: encephalomeningitis Chronic type: focal epilepsy

Complications of Liver Cirrhosis

Varicosity of esophagus-fundusstomach Hemorrhage of upper gastrointestinal tract Hepatic encephalopathy (HE) Spontaneous bacteria peritonitis (SBP)

Complications of intestinal tract

Appendicitis

Intestinal obstruction and cancroid change

Differential Diagnosis Acute schistosomiasis: typhoid fever; amebic liver miliary abscess; tubercular peritonitis;
tuberculosis; bacillary dysentery; malaria;etc. etiology test and X-ray of chest are diagnostic. Chronic schistosomiasis:anicteric viral hepatitis;amebic dysentery; chronic bacillary dysentery; Terminal schistosomiasis: portal liver cirrhosis and necrosis liver cirrhosis

Prognosis Factors affect the prognosis:

The continuance of infection The last of pathogenesis The age of the patients The complications

Prevention
Control of the source of infection: Treat the patients and domestic animal at the same time. Cut off the route of transmission: Snail control Sanitary disposal of human excreta Protect of susceptive people:avoid the contact with schistosome-infected water