Shistosomiasis Ped

8/2/2019 Shistosomiasis Ped

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Reporter: Ped C. Silvestre


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Introduction


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Acute schitosomiasis:fever,enlargement andtenderness of the liver,eosinophilia,and dysentery

Chronic schitosomiasis : fibro-obstructive lesion

around the portal vessels

Late stage: giant spleen, ascites, hypertension of

portal venous system

Introduction


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The method of disposal of humanexcreta

The presence of the snail intermediatehost

The contact with cercaria-infected

water

Three Major Factors


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s.m

s.j

s.h

OncomelaniaQuadrasi


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Ingestion of

contaminated

water

Contact with

cercaria-infected

water

Poor

sanitation

Endemic areas

Presence of snail

INTERMIDIATE HOST OF CECARIAE

Increased susceptibility


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Penetration of cercariae into the skin

(3 days to reach the capillaries)

Schistosomule enters the bloodstream

(2-3wk old)Schistosomes matures inhepatic portal veins

(LIVER)

(week5)Pair Schistosome migrates and layeggs to other organs


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SCHISTOSOMIASISINTESTINE

(S. Japonicum and S. Mansoni)

BLADDER

(S. Haematobium)

Blood Routine Test:

Acute

stage :eosinophilia is

characteristic

change.WBC raise to

10-30G/L

Chronic

stage:eosinophil

slightly or moderate

rise

Terminal stage: WBC

and platelets are lower

Liver Function Test:

Acute stage: serum

globulin rise, ALT

slightly rise

Chronic stage: most

patients have a normal

liver function,

especially

asymptomatic

Terminal stage: serum

ALB descend caused

by liver cirrhosis

Stool Test :

The discovery of eggsin stool is the evidenceof diagnosis by directsmear or othermethodsImaging test:B-ultrasound: the

degree of liver cirrhosisCT: the image of liverand brainX-ray: chest;esophagus; andgastrointestinal tract

DRUGS:

Praziquantel isthe best choice ofdrug for thetherapy ofschistosomiasis.

Oxamniquine

for S. mansoniMetrifonate forS. haematobium


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The history of contact with schistosome-infectedwater.

Schistosome dermatitis

Incubation period: 23-73 days, average 1 month

Acute Schistosomiasis


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Clinical manifestations come out after 4 to 8 weeksof infection, similar to the time from egg to adult

worm (40 days)

Fever: intermittent, maintain weeks to monthsAllergic reaction:urticaria, angioneuroedema,

enlargement of lymph nodes and eosinophilia

Digestive syndromes: abdominal pain, diarrheawith pus and blood, constipation or diarrhea

Hepatosplenomegaly

Acute Schistosomiasis


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Asymptomatic: most person are asymptomatic Symptomatic: the most common syndrome is

abdominal pain with intermittent diarrhea.

hepatosplenomegaly

Chronic Schistosomiasis


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Liver cirrhosis is the prominent syndrome of this

stage

According to the manifestations , it can be divided

into three types:

The type of giant spleen

The type of ascites

The type of dwarf

Terminal stage of

schistosomiasis


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Schistosomiasis in lungs:found in acute schistosomiasis, by egg deposition.

Symptoms are light and signs are not clear

Schistosomiasis in brain:

Acute type: encephalomeningitis

Chronic type: focal epilepsy

Ectopic Lesion


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Varicosity of esophagus-fundus-

stomach

Hemorrhage of upper gastrointestinaltract

Hepatic encephalopathy (HE)

Spontaneous bacteria peritonitis (SBP)

Complications of LiverCirrhosis


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Appendicitis

Intestinal obstruction and cancroidchange

Complications of intestinal

tract


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Acute schistosomiasis:typhoid fever; amebic liverabscess; tubercular peritonitis; miliary

tuberculosis; bacillary dysentery; malaria;etc.

etiology test and X-ray of chest are diagnostic.Chronic schistosomiasis:anicteric viral

hepatitis;amebic dysentery; chronic bacillary

dysentery;Terminal schistosomiasis: portal liver cirrhosis

and necrosis liver cirrhosis

Differential Diagnosis


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Factors affect the prognosis:

The continuance of infection

The last of pathogenesis

The age of the patients

The complications

Prognosis


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Control of the source of infection:

Treat the patients and domestic animal at the same

time.Cut off the route of transmission:

Snail control

Sanitary disposal of human excreta

Protect of susceptive people:avoid the contact withschistosome-infected water

Prevention

Shistosomiasis Ped

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