Difference between revisions of "Schistosomiasis"

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==Clinical Features==
 
==Clinical Features==
 
===Acute===
 
===Acute===
*Cutaneous rash/itching from cercariae penetration (immediate)
+
*Cutaneous [[rash]]/[[pruritus]] from cercariae penetration (immediate)
*Katayama fever-Fever, [[abdominal pain]], Fatigue, Cough, [[Diarrhea]], Eosinophilia (lasts 4-8 weeks)
+
*Katayama fever
 +
**[[Fever]], [[abdominal pain]], [[fatigue]], [[cough]], [[diarrhea]], [[eosinophilia]]
 +
**Lasts 4-8 weeks
  
 
===Chronic (mostly a chronic condition)===
 
===Chronic (mostly a chronic condition)===
*Second most common cause of esophageal varicies worldwide
+
*Second most common cause of [[esophageal varices]] worldwide
 
*Greatly elevated bladder cancer rates in endemic areas
 
*Greatly elevated bladder cancer rates in endemic areas
*Can cause renal failure, liver failure, [[pulmonary hypertension]], [[GI bleed]]s and rarely CNS symptoms
+
*Can cause [[renal failure]], [[liver failure]], [[pulmonary hypertension]], [[GI bleed]]s and rarely CNS symptoms
 
**Mostly through fibrosis of affected organs
 
**Mostly through fibrosis of affected organs
 
*Genitourinary schistosomiasis
 
*Genitourinary schistosomiasis
Line 24: Line 26:
 
*[[UTI]]
 
*[[UTI]]
 
*[[STD]]
 
*[[STD]]
*Intestional parasites
+
*Intestinal [[parasites]]
 
*[[Traveler's diarrhea]]
 
*[[Traveler's diarrhea]]
  
Line 35: Line 37:
 
*CBC, Alk Phos, GGT, ALT/AST, Cr, Blood cultures
 
*CBC, Alk Phos, GGT, ALT/AST, Cr, Blood cultures
 
*Consider [[ultrasound]] for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
 
*Consider [[ultrasound]] for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
*Echo and CXR for pulmonary hypertension and/or cor pulmonale
+
*[[Echocardiography]] and [[CXR]] for pulmonary hypertension and/or cor pulmonale
 
*Consider CT or MRI for CNS disease or further workup of periportal fibrosis
 
*Consider CT or MRI for CNS disease or further workup of periportal fibrosis
  
 
==Management==
 
==Management==
*Praziquantel 20mg/kg PO for two doses in 1 day <ref>CDC. Schistosomiasis. http://www.cdc.gov/parasites/schistosomiasis/health_professionals/index.html</ref>
+
*[[Praziquantel]] 20mg/kg PO for two doses in 1 day <ref>CDC. Schistosomiasis. http://www.cdc.gov/parasites/schistosomiasis/health_professionals/index.html</ref>
 
**S.japnonicum requires 3 doses in 1 day
 
**S.japnonicum requires 3 doses in 1 day
  

Revision as of 17:23, 26 August 2019

Background

  • Caused by parasitic trematodes of the species Schistosoma
  • Reservoir is freshwater snails
  • Endemic in areas of Africa and Southern Asia
  • The Cercariae (the stage of trematode released by the snail) can infect by direct penetration through the skin
  • Infects >200million people worldwide with 10% suffering severe consequences

Clinical Features

Acute

Chronic (mostly a chronic condition)

  • Second most common cause of esophageal varices worldwide
  • Greatly elevated bladder cancer rates in endemic areas
  • Can cause renal failure, liver failure, pulmonary hypertension, GI bleeds and rarely CNS symptoms
    • Mostly through fibrosis of affected organs
  • Genitourinary schistosomiasis
    • Caused by sores in the genital tract
    • May persist even after treatment
    • Greatly increases risk of HIV infection

Differential Diagnosis

Evaluation

Work-up

  • ELISA
  • PCR from stool or urine
  • Stool and Urine for ova/parasites
    • biopsy may be needed for those who do not show ova/parasites in stool/urine
  • CBC, Alk Phos, GGT, ALT/AST, Cr, Blood cultures
  • Consider ultrasound for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
  • Echocardiography and CXR for pulmonary hypertension and/or cor pulmonale
  • Consider CT or MRI for CNS disease or further workup of periportal fibrosis

Management

  • Praziquantel 20mg/kg PO for two doses in 1 day [1]
    • S.japnonicum requires 3 doses in 1 day

Disposition

  • Generally may be discharged
  • Admit if concern for CNS infection

See Also

External Links

References