Difference between revisions of "Schistosomiasis"

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=Background=
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==Background==
 
*Caused by parasitic trematodes of the species Schistosoma
 
*Caused by parasitic trematodes of the species Schistosoma
 
*Reservoir is freshwater snails
 
*Reservoir is freshwater snails
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*Infects >200million people worldwide with 10% suffering severe consequences
 
*Infects >200million people worldwide with 10% suffering severe consequences
  
=DDx=
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==Clinical Features==
*[[UTI]]
 
*[[STD]]
 
*Intestional parasites
 
*[[Traveler's diarrhea]]
 
 
 
=Diagnosis=  
 
 
*Mostly a chronic condition
 
*Mostly a chronic condition
 
**Second most common cause of esophageal varicies worldwide
 
**Second most common cause of esophageal varicies worldwide
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**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)
  
*Diagnosis
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==Differential Diagnosis==
 +
*[[UTI]]
 +
*[[STD]]
 +
*Intestional parasites
 +
*[[Traveler's diarrhea]]
 +
 
 +
==Diagnosis==
 +
===Work-up===
 
**ELISA
 
**ELISA
 
**PCR from stool or urine
 
**PCR from stool or urine
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**Consider CT or MRI for CNS disease or further w/u of periportal fibrosis
 
**Consider CT or MRI for CNS disease or further w/u of periportal fibrosis
  
=Treatment=
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===Evaluation===
 +
 
 +
 
 +
==Management==
 
*Praziquantel 20mg/kg PO for two doses in 1 day
 
*Praziquantel 20mg/kg PO for two doses in 1 day
 
**S.japnonicum requires 3 doses in 1 day
 
**S.japnonicum requires 3 doses in 1 day
  
=Sources=
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==Disposition==
*Wikipedia
+
 
*CDC.gov/parasites/schistosomiasis
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==See Also==
*Uptodate
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*Tintinalli
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==External Links==
*Colley DG, Bustinduy AL, Secor WE, King CH. Human Schistosomiasis. Lancet. 2014 Jun 28;383(9936):2253-64.
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 +
==References==
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<references/>
  
 
[[Category:ID]]
 
[[Category:ID]]
 
[[Category:TropMed]]
 
[[Category:TropMed]]

Revision as of 20:26, 4 September 2015

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

  • Mostly a chronic condition
    • Second most common cause of esophageal varicies worldwide
    • Greatly elevated bladder cancer rates in endemic areas
    • Can cause renal failure, liver failure, pulmonary hyptertension, 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
  • Acute presentations
    • Cutaneous rash/itching from cercariae penetration (immediate)
    • Katayama fever-Fever, Abdominal pain, Fatigue, Cough, Diarrhea, Eosinophilia (lasts 4-8 weeks)

Differential Diagnosis

Diagnosis

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 Cx
    • Consider US for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
    • Echo and CXR for pulmonary HTN and/or cor pulmonale
    • Consider CT or MRI for CNS disease or further w/u of periportal fibrosis

Evaluation

Management

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

Disposition

See Also

External Links

References