Diagnosis

Schistosomiasis

Etiology

Cause [jv7][emo]

• S haematobium, S mansoni, and S japonicum

• Less prevalent species: S mekongi and S intercalatum

• A trematode (parasitic flatworm commonly known as a blood fluke)

Pathophysiology [jv7][emo]

1. Freshwater snails release larva stage of schistosomes (cercariae)

2. The larva penetrate the human skin during contact with infested water

3. The larvae develop into adult schistosomes in vivo and digest erythrocytes

4. The minimally immunogenic adult worms live in the blood vessels and release eggs

5. Lifespan of 3 to 7 years (ranging from 20 to 290 eggs per day in S. haematobium)

6. Schistosomiasis is the pathologic immune reaction to Schistosoma eggs in the tissues

   • Antigens released from the egg stimulate a granulomatous reaction involving T cells, macrophages, and eosinophils

   • Results in fibrosis, organ damage and clinical disease

7. Symptoms and signs depend on the number and location of eggs trapped:

   • Intestinal: Worms in the mesenteric venules releases eggs into the intestines

   • Urogenital: Worms in the urogenital venules releases eggs into the urinary tract

   • Other: Skin, brain (embolization of eggs), muscle, adrenal glands, and eyes

Complications [jv7][emo]

• Gastrointestinal bleeding

• Gastrointestinal obstruction

• Renal failure

• Pyelonephritis

• Bladder Cancer (2nd leading cause of bladder cancer worldwide) [emo]

• Liver Cancer

• Gallbladder Cancer

• Sepsis

• Pulmonary hypertension

• Portal hypertension

• Cor pulmonale

• Neuroschistosomiasis

• Infertility

• Anemia

• Spontaneous abortion

• Ectopic pregnancy

Epidemiology

Incidence per 100.000 [uzb][rbg]

Approach

• Blood test: Complete blood count, eosinophilia, GGT, transaminase, renal function

• Blood culture

• Urine culture

• Stool culture

• Urine PCR

• Urine microscopy

• Serelogy

• Antigen test

• Ultrasound abdomen

• CT abdomen

• CT thorax

• CT/MRI caput

• Echocardiography

• Biopsy

• Cystoscopy

• Coloscopy

• Gastroscopy

• Bronchoscopy

• Lumbar puncture

Treatment

1. Stabilize the patient [jv7][emo]

2. Treat acute complications: intestinal bleeding, renal failure, cardiac failure, bacteremia, and CNS complications

3. Antischistosomal drug:

   • Praziquantel 40 mg/kg (one dose) or 20 mg/kg every 4-6 hours for three doses

4. Corticosteroids: Reduce inflammation

5. Surgery: Removal of tumor masses, ligation of esophageal varices, porta-caval shunt surgeries, extirpation of granulomas in urinary bladder or lungs

Differential diagnoses

Acute pancreatitis, Appendicitis, Bladder cancer, Chlamydia, Cirrhosis, Clonorchiasis, Crohn disease, Drug side effects, Epididymitis, Epilepsy, Gastroenteritis, Glomerulonephritis, Gonorrhea, Heart failure, Herpes simplex, HIV, Leishmaniasis, Leukemia, Malaria, Pulmonary edema, Pulmonary hypertension, Pyelonephritis, Renal cell carcinoma, Salmonellosis, Serum sickness, Spinal cord infection, Trichinosis, Tuberculosis, Typhoid fever, Ulcerative colitis, Ulcer disease, Urinary retention, Urinary tract infection, Viral hepatitis