Objective know the global distribution of schistosomiasis

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Presentation transcript:

gastrointestinal block week 3 schistosomiasis & Fasciolopsiasis trematode parasites

Objective know the global distribution of schistosomiasis   describe the life cycle of schistosomiasis compare relation between chronic schistosomiasis and portal hypertension know pathology, diagnosis and treatment of schistosomiasis know life cycle of Fasciola hepatica know pathology , diagnosis and treatment of Fasciola hepatica compare between true infection and sheep liver infected with Fasciola hepatica which lead to false infection

Definition Schistosomiasis is a chronic, parasitic disease caused by blood flukes Blood trematodes (trematode worms) of the genus Schistosoma also known as bilharzia, ETIOLOGY a. Schistosoma haematobium b. Schistosoma mansoni c. S. japonicum Two forms of schistosomiasis exist Intestinal schistosomiasis and 2. Urogenital schistosomiasis

Epidemiology The disease is found in Africa, South America, East Asia and Middle East Over 230 million people require treatment for schistosomiasis yearly 90% of those requiring treatment for schistosomiasis live in Africa. More than 200,000 deaths per year are due to schistosomiasis in sub-Saharan Africa

Mode of transmission Infection occurs when your skin comes in contact with contaminated freshwater in which certain types of snails that carry schistosomes are living. Freshwater becomes contaminated by Schistosoma eggs when infected people urinate or defecate in the water. If you live in or travel to areas where schistosomiasis occurs and your skin comes in contact with freshwater from canals, rivers, streams, ponds, or lakes, you are at risk of getting schistosomiasis. اسم ورقم المقرر – Course Name and No. 5/11/2019

Life cycle of schistosomiasis

Life cycle (Eggs  larvae  into snail) Parasite eggs released into freshwater (from human urine, feces) Eggs hatch  ciliated miracidia, free swimming Miracidia find & infect snail host (different species prefer diff’t snail sp.) Each miracidia transforms into many fork-tailed, free swimming forms called cercariae within 4-6 weeks of entering snail. Cercariae leave snail and move into water up to 18 days. اسم ورقم المقرر – Course Name and No. 5/11/2019

Life cycle (Into human  lymphatics  lungs  liver) 6. Cercariae find a human host, penetrate skin, and differentiate into larval forms called schistosomulae. 7. Migrate through the host’s skin, gain access to the lymphatic system. 8. Travel to the lungs (stay 3-8 days and ~70% are eliminated) 9. Migrate to liver portal system, mature into male & female adults اسم ورقم المقرر – Course Name and No. 5/11/2019

Life cycle (maturation  movement to target organs  egg production) 10. In liver, m & f pair up  female inserts herself into the gynecophoral canal of male  they are now ‘paired’. 11. Migrate to favoured sites: S. mansoni – mesenteric venules of large bowel & rectum S. japonicum – mesenteric veins of the small intestine S. haematobium – perivesical venous plexus surrounding the bladder Egg lyes 50% comes out 50%trapped in tissues, carried away by blood circulation, lymph. causing an immune reaction and progressive damage to organs.

SIGNS & SYMPTOMS Clinical picture: low grade fever. Fatigue, weight loss and anemia Intestinal schistosomiasis Abdominal pain 2. Diarrhea 3. Blood in stool, fresh or melena 4. Hematemesis 5. Liver enlargement Urogenital schistosomiasis 1. Hematuria (terminal) 2. dysuria 3. Frequent need to urinate (polyuria) 4. In females; genital lesions, vaginal bleeding, pain during sexual intercourse and nodules on the vulva, irregular menstruation اسم ورقم المقرر – Course Name and No. 5/11/2019

Schistosoma dermatitis or “swimmers itch (Early) acute infection Katayama fever fever urticaria malaise diarrhea اسم ورقم المقرر – Course Name and No. 5/11/2019

Chronic Infection (Late) Symptoms of chronic infection caused by eggs that travel to various parts of body Eggs remain trapped in host tissues  secrete Ags  granulomatous inflammatory immune response Granuloma اسم ورقم المقرر – Course Name and No. 5/11/2019

Chronic Infection When eggs meet the liver/spleen) Hepatosplenic schistosomiasis Eggs carried by portal circulation  liver Granulomatous response Granulomas are walled off with fibrous tissue  fibrosis obstructs portal veins  portal hypertension Esophageal varices (dilated esophageal veins, which drain the liver bursting can cause bleeding to death. Hypovolemic shock Caused directly by portal hypertension.) Splenomegaly (enlarged spleen, due to fibrosis)

Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein 

Chronic Infection When eggs meet the genitourinary areas & CNS Genitourinary complications Eggs lodge themselves in wall of bladder & can develop into polyps Polyps can erode, ulcerate & cause hematuria (blood cells in urine) Eggs lodge in ureters and urethra, cause lumps and lesions  kidney failure Eggs lodge into ovaries, the uterus, cervix, fallopian tubes  lumps  complications incl. infertility (For the men: eggs can also lodge into the testes and the prostate ) CNS complications S. haematobium and S. mansoni can migrate to the spine S. japonicum found in the brain and causes encephalopathy (general brain dysfunction)

Diagnosis Microscopic Detection Take stool or urine sample to detect eggs S. haematobium eggs s.haematobium are oval and have a spike at the tip S. japonicum eggs small and almost spherical with tiny spine S. mansoni eggs have a spike on the side (spine) s.mansoni

Treatment Metrifonate  against S. haematobium Niridazole  against S. japonicum Oxamniquine  against S. mansoni WHO recently approved use of combo of 3 drugs at once (rule is always no more than 2) to cure a few related diseases (incl. Schistosomiasis) in hopes that eradication will be faster. Complications Drugs ineffective when fibrosis has developed - treatment is then focused on managing the complications (e.g. portal hypertension) Anticonvulsants may be needed in patients with CNS complications (S. japonicum).

Fasciola hepatica is known as Common/ Sheep Liver Fluke(trematodes) causes the disease fascioliasis is one of the largest flukes of the world (30 mm by13 mm) is leaf-shape, pointed at the end has small but powerful oral sucker The acetabulum is larger than the oral sucker

The life cycle

Life cycle Fasciola hepatica: Sheep liver fluke, causes disease primarily in sheep and other domestic animals • Humans are infected by eating watercress (or other aquatic plants) contaminated by larvae (metacercariae) that excyst in the duodenum, penetrate the gut wall, and reach the liver, where they mature into adults • Hermaphroditic adults in the bile ducts produce eggs, which are excreted in the feces • The eggs hatch in fresh water, and miracidia enter the snails

Life cycle Miracidia develop into cercariae, which then encyst on aquatic vegetation • Sheep and humans eat the plants, thus completing the life cycle • Symptoms are due primarily to the presence of the adult worm in the biliary tract • In early infection, right-upper-quadrant pain, fever, and hepatomegaly can occur, but most infections are asymptomatic • Months or years later, obstructive jaundice can occur • Diagnosis is made by identification of eggs in the feces

Signs and symptoms Incubation phase: from the ingestion of metacercariae to the appearance of the first symptoms; time period: few days Invasive or acute phase: fluke migration up to the bile ducts This phase is a result of mechanical destruction of the hepatic tissue and the peritoneum The major symptoms of this phase are: Fever: usually the first symptom of the disease; 40–42 °C Abdominal pain Gastrointestinal disturbances: loss of appetite, flatulence, nausea, diarrhea Urticaria Respiratory symptoms (very rare): cough, dyspnoea, chest pain, hemoptysis Hepatomegaly and splenomegaly Ascites Anaemia Jaundice اسم ورقم المقرر – Course Name and No. 5/11/2019

Pathogenesis The development of infection in definitive host is divided into two phases: the parenchymal (migratory) phase and the biliary phase During the migration of flukes, tissues are mechanically destroyed and inflammation appears around migratory tracks of flukes In biliary ducts, flukes mature, feed on blood, and produce eggs. Hypertrophy of biliar ducts associated with obstruction of the lumen occurs as a result of tissue damage. Hypertrophia of bile ducts in liver caused by F. hepatica (liver section of an infested goat)

Lab diagnosis Treatment Most immunodiagnostic tests will detect infection and have a sensitivity above 90% during all stages of the diseases diagnosis of fasciolosis is usually achieved parasitologically by findings the fluke eggs in stool, Treatment A medication called triclabendazole is commonly used to treat a liver fluke infection, as this effectively kills the liver flukes and their eggs. Other drugs, such as pain relievers, may be used to treat some of the symptoms such as pain and diarrhea. Surgery may be necessary in rare cases where cholangitis, an infection of the bile ducts in the liver, has developed.

End Thank you four your attention Any question