Difference between revisions of "Schistosomiasis"

(Work-up)
(Work-up)
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**Stool and Urine for ova/parasites
 
**Stool and Urine for ova/parasites
 
***biopsy may be needed for those who do not show ova/parasites in stool/urine
 
***biopsy may be needed for those who do not show ova/parasites in stool/urine
**CBC, Alk Phos, GGT, ALT/AST, Cr, Blood Cx
+
**CBC, Alk Phos, GGT, ALT/AST, Cr, Blood cultures
 
**Consider US for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
 
**Consider US for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
 
**Echo and CXR for pulmonary HTN and/or cor pulmonale
 
**Echo and CXR for pulmonary HTN and/or cor pulmonale

Revision as of 00:35, 15 July 2016

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 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
  • 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 cultures
    • 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 workup of periportal fibrosis

Evaluation

Management

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

Disposition

See Also

External Links

References