• PREVALENCE OF SCHISTOSOMIASIS AS REPORTED BY THE STATION

__________________________________________

Prevalence (%)

No. of Overall

Persons S. Haema- S.Man- Preva Station Examined tobium soni lence+

____________________________________________

Al Baha 20.142 -- 13.0 13.0

Jizan 30.883 7.0 1.2 8.2

Taif 39.559 0.2 7.7 7.9

Abha 23.013 1.7 4.9 6.6

Madinah 17.591 1.9 3.6 5.5

Prevalence (%)

No. of OverallPersons S. Haema- S.Man- Preva

Station Examined tobium soni lence+____________________________________________

Bisha 16.766 0.4 8.5 8.9Najran 8.820 1.6 9.9 11.5Mahael 5.783 7.6 --- 7.6Hayil 4.335 --- 14.2 12.2Riyadh 15.129 --- 5.6 5.6Makkah 25.894 2.5 3.0 5.5Al-Jouf 12.577 1.3 1.6 2.9

Portal Vein

RectalInf. Mesentery

S P

KATAYAMA FEVER(KATAYAMA River, Japan)

1. SEVERAL DAYS – 2-3 WEEKS

2. FEVER, CHILLS, HEADACHE, MALAISE, EDEMA, CONFUSION

3. HEPATOSPLENOMEGALLY

4. LYMPHADENOPATHY

5. EOSINOPHILIA

6. CEREBRAL EDEMA (CT)

S. MANSONI (SYMPTOMS)SYMPTOM CASES

Abdominal Pain 258

Fatigue 221

Blood in Stool 205

Mucous in Stool 191

Tenesmus 121

Depression 108

Diarrhea 54

1Constipation 1

Oes. varices

Communication with

Systemic Circulation

Pulmonary Artery

BOTH (MANSONI & Haema.)

SYMPTOMS

Haematuria - 11

Abdominal Pain - 7

Tiredness - 7

Frequency - 6

Depression - 4

Tenesmus - 4

Blood in Stool - 3

Mucous in Stool - 3

U SCHISTOSOMIASIS

Kidney

U. Bladder

SIDE EFFECTS OF ANTISCHISTOSOMAL DRUGS (%)

METRIFONATE OXAMNIQUINE PRAZIQUANTEL SYMPTOMS

40 30 56 NONE

10 36 20 DIZZINESS

12 25 12 ABDOMINAL PAIN

10 12 10 JOINT PAIN

6 10 8 NAUSIA

2 4 6 RASH

SIDE EFFECTS OF ANTISCHISTOSOMAL DRUGS (%)

8 10 6 VOMITING

- 10 6 ITCHING

8 12 2 FATIGUE

- - 2 HAIRFALL

2 2 1 CHANGE IN TASTE

4 2 1 DIARRHEA

- 1 - CONVULSION

LEISHMANIASIS

It is the result of the infection with one of or other species of protozoa (leishmania). Conveyed by:

Sandflies (Phlebotomus).

Visceral Leishmaniasis: L. donovani

Mucocutaneous : L. Braziliensis

Cutaneous : L. tropica major L. tropica minor

New World : L. Braziliensis L. Mexicana

Oldworld

PATHOLOGY

» L. donovani parasitizes the reticu. endoth. cells

» Great proliferation of macrophage

» Cells result: Liver – spleen enlarg.

» The red bone marrow extend.

»

CLINICAL PICTURE•Incubation : 2 weeks – 18 months

early stages is not easy for diagnose. There is no constant physical signs.

BP , Pulse , - Fever

☺ Changes in the blood picture particularly Leucopenia.☺ Outstanding physical sign is the enlargement of the spleen 3 cm. a month.

● Liver : enlarged spleen + liver are neither tender nor painful.

● Sometimes: Jaundice = prognost. Significance

● Enlarged : Lymph node, could be but its not a feature of

the disease.

● Wasting : Emaciated pat with a protuberant

Abdomen ( liver + spleen enlarged)

●Fever : Without subjective symptoms of fever – no delirium.

● Sometimes: there is no fever

● Skin : dry, rough. The natural pigmentation of the skin over

the bone and around the mouth is deepened. (Kala azar??)

● Hair : fallout

● Lungs : Bronchopneumonia

● GIT : Diarrhea, dysentery

DIAGNOSIS1. Needle aspiration

Bone – sternum – liver, spleenHistology – cultureL. donovani body

2. a. Leucopenia: Neutropenia – relative mononucleosis.

b. Progressive fall with the red cell count

3. Formalin gel (aldehyde)

2 drops formalin + 2 ml serum

After 20 min, white ring

4. Complement fixation and fluorescentFalse positive trypanosomal infection

5. The complement fixation – early positive – negative after cure. Sometimes + or – lung. Other diseases.

6. Fluorescent antibody

7. IV + V: In trypanosomal infection

8. Skin test (Montenegro)Delayed hypersensitivity reaction

0.2 ml. suspension

PROPHYLAXISImmunity: Kala Azar permanent immunity

to all L. Donovani.• L. tropica major crass immunity to L.

tropica minor. Not the opposite.• L. brazillienses to L. mexican + but not vice

versa.

Vaccine: L. tropica major – living leptomonads.

L. donovani: Intradermally or s.c. local leishmanial infection. (Leichmanioma) Developing

immunity. No visceral L.

TREATMENT1. Antimonial –

i. Urea, stibamine, pentavalen + antmonyia

• I.V. daily or every 2 days

• 6 – 10 dose

• First 100 mg then 200 then 250

• Total dose 2 – 5 g. adult

Side Effect: Nausea, vomiting, joint pain, Abdominal pain, diarrhea

Contraindication: Liver and kidney failure

ii. Sodium stibogluconate (Pentostam)• I.M. – 600 mg total daily for 6-10 days• Repeated after 14 days; if needed• Side effect: Anaphylactic shock

2. Diamidiem – • Pentamidine isothionate• Dose 3 -4 mg / kg / BW total 300 mg

Side effect: Hypoglycemia