Schistosomiasis (Bilharzia) Alexis Flen| Infectious Diseases | UNC Chapel Hill Treatment Schistosomiasis Rational Drug Treatment Strategy Neglected Tropical Disease Nematode Worm Fluke Zoonotic Strains Praziquantel If 50% of children have bloody stool the area is treated Cause Vaccination is not available PZQ resistance in two endemic areas and limitations Strategy Molecular Masking Modification of host immune response Malaria Drugs Plant derived products Cause and Effect World Distribution Endemic Impoverished tropical areas that have unsanitary water conditions Symptoms Fever, chills, sweating, headache, diarrhea Liver damage leads abdominal swelling Morbidity Extended life span Schistosoma become resistant to treatment Immunosuppression and lesions Death Predominately 90% of cases occur in Africa 70 million DALYS Cercarie mortality before and after treatment Sanguinarine caused paralysis Plumbagin caused muscle contractions and head splitting Intervention Strategies Transmission Intestinal Urogenital Rare Cases of Spinal and Cerebral 1.88 lg/ml for Plumbagin and 3.68 lg/ml for Sanguinarin resulted in100% mortality in 48 hours Can both alter the tegumental structure of the worms, which impacts the interface between the host and parasite Country Time Strategy Status Brazil 1975-1993 Morbidity control (preventive chemotherapy using oxaminquine), health education, water supply and sanitation. Additionally, limited snail control (niclosamide) Controlled China 1940s-present Chemical molluscicides environmental management, large-scale community participation and mechanization of agriculture, fencing of water buffalos Japan 1950-1990s Multisector Health Campaign continual surveillance, lining of canals and deworming of schools Eliminated Saudi Arabia N/A Snail control (chemical control using molluscicides) and environmental management; occasionally chemotherapy and health education. Later, biological control (competitor snails) Close to Elimination Immune Response Works Cited TH1 response leads to inflammation TH2 response leads to granulomas Chronic infection results in inability to combat infection with granulomas and subsequent fibrosis Blanchard, Tom J. "Schistosomiasis." Travel Medicine and Infectious Disease 2.1 (2004): 5-11. Print. Pearce, Edward J., and Andrew S. Macdonald. "The Immunobiology of Schistosomiasis." Nature Reviews Immunology 2.7 (2002): 499-511. Print. "Prevention & Control." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 07 Nov. 2012. Web. 18 Mar. 2014. Rollinson, David, Stefanie Knopp, Sarah Levitz, J. Russell Stothard, Louis-Albert Tchuem Tchuenté, Amadou Garba, Khalfan A. Mohammed, Nadine Schur, Bobbie Person, Daniel G. Colley, and Jürg Utzinger. "Time to Set the Agenda for Schistosomiasis Elimination." Acta Tropica 128.2 (2013): 423-40. Print. "Schistosomiasis (bilharzia) ." Schistosomiasis (bilharzia). N.p., n.d. Web. 18 Mar. 2014. Tchuenté, Louis-Albert Tchuem, Sabine C. Momo, J. Russell Stothard, and David Rollinson. "Efficacy of Praziquantel and Reinfection Patterns in Single and Mixed Infection Foci for Intestinal and Urogenital Schistosomiasis in Cameroon." Acta Tropica 128.2 (2013): 275-83. Print. Zhang, Si-Ming, and Kristen A. Coultas. "Identification of Plumbagin and Sanguinarine as Effective Chemotherapeutic Agents for Treatment of Schistosomiasis." International Journal for Parasitology: Drugs and Drug Resistance 3 (2013): 28-34. Print.