1. Schistosomiasis By Mohammed Mahmoud, MD Lecturer of tropical Medicine Cairo university

2. Specices & Distribution S. Mansoni : Nile valley, Sudan, Brazil and Venzezuella S. Mansoni : Nile valley, Sudan, Brazil and Venzezuella S. Haematobium: Upper Egypt, Africa, Western Asia S. Haematobium: Upper Egypt, Africa, Western Asia S. Japonicum: Far East S. Japonicum: Far East

3. Life Cycle

4. Basic pathology Cercaria  Allergic dermatitis Cercaria  Allergic dermatitis Adults  No harm Adults  No harm Eggs  granulomas  Fibrosis Eggs  granulomas  Fibrosis  egg antigens  immune complexes  Katayama fever  egg antigens  immune complexes  Katayama fever

5. Clinical picture Cercarial dermatitis: pruritic rash occurs within 24 h of cercarial penetration Cercarial dermatitis: pruritic rash occurs within 24 h of cercarial penetration Katayama fever: Katayama fever: - Usually with S. japonicum (???) - Heavy infection with mansoni - Occur in non-immune persons - 4-6 weeks after primary infection (time of egg deposition) - Fever, rigors, HSM, LN, ulticarial rash, marked eosionophilia

6. Urogenital schistosomiasis: Urogenital schistosomiasis: - S.haematobium - affect UB, ureter, genital organs - Dysuria, terminal haematuria Complications: 1- Obstructive uropathy 2- Cancer bladder (squamous cell)

7. Intestinal schistosomiasis: Intestinal schistosomiasis: - caused by mansoni - affect large bowel (rectum and sigmoid) - due to submucosal egg deposition  granumona  fibrosis - Clinically: 1- Bilharzial dysentery dysentery, tensmus, mucus in stools, crampy abdominal pain 2- Colonic polyposis Bloody diarrhea, anemia, hypoprotinemia, clubbing of fingers (never turn malig) 3- Bilharzioma: Tender palpable mass in Lt iliac fossa Never turn malignant

8. Hepatic schisosomiasis Caused by S. Mansoni, S. Japonicum Caused by S. Mansoni, S. Japonicum Stages: Stages: 1- Stage of hepatomegly : ovideposition and granuloma formation liver is enlarged, smooth, firm, rounded edge. 2- Stage of HSM (Mainly due RES) 3- Stage of Huge splenomegly (PH) and shrunken liver (periportal fibrosis) and PS collaterals. 4- Stage of ascites (PH and hypoprotinemia, late due to malnutrition, loss of proteins by colonic polyposis and haematemesis) 5- Terminal hepatic failure concomitant viral hepatitis Reversal of the blood flow away from the liver (PS)

9. Periportal fibrosis

10. Paraumbilical vein

11. Oesophageal varices

12. Cardiopulmonary Schistosomiasis Larval Pneumonitis: allery to schistosomulae migrations  low grade fever, cough, haemoptysis, wheezes, eosionophilia Larval Pneumonitis: allery to schistosomulae migrations  low grade fever, cough, haemoptysis, wheezes, eosionophilia Core pulmonale: due to eggs of S. mansoni (reach through PS collaterals), S. haemtobium Core pulmonale: due to eggs of S. mansoni (reach through PS collaterals), S. haemtobium pulmonary arterioles  granuloma  fibrosis  endertaritis oblitrans  pulmonary HT  RVH  RVF X-ray  dilatation of main pulmonary arteries (Dumble shape masses at the hilum)

13. Schistosomal corepulmonale

14. Ectopic Schistosomiasis Due to aberrant migration of the eggs Due to aberrant migration of the eggs Mainly affect brain (seizures), spinal cord (paraplegia), eye (visual field defects), skin. Mainly affect brain (seizures), spinal cord (paraplegia), eye (visual field defects), skin.

15. Chronic salmonellosis Salmonella behave atypical in cases of schistosomiasis following a rather chronic course unlike the usual acute illness Salmonella behave atypical in cases of schistosomiasis following a rather chronic course unlike the usual acute illness Due to proliferation of salmonella in the gut of the adult schistosomes, shedding salmonella into blood  chronic bacteraemia  prolonged fever Due to proliferation of salmonella in the gut of the adult schistosomes, shedding salmonella into blood  chronic bacteraemia  prolonged fever Ttt by antityphoid to eradicate salmonella and prevent relapse by antischistosomal therapy. Ttt by antityphoid to eradicate salmonella and prevent relapse by antischistosomal therapy.

16. Diagnosis Stool and urine examination Stool and urine examination Rectal snip (gold standard) Rectal snip (gold standard) Liver biopsy Liver biopsy Serological tests: Serological tests: Ab detection  donot differentiate between active and past infection, did not decrease after ttt Ab detection  donot differentiate between active and past infection, did not decrease after ttt Ag detection  indicate active infection and decrease after successful ttt Ag detection  indicate active infection and decrease after successful ttt

17. Treatment Praziquantel (Drug of choice) Praziquantel (Drug of choice) for both mansoni and haematobium, 40 mg/kg, can be repreated 2 or 3 times in moderate and severe infections Metrifonate: for S.haematobium 10 mg/kg in 3 repeated doses at 2 weeks interval Metrifonate: for S.haematobium 10 mg/kg in 3 repeated doses at 2 weeks interval Oxamniquine: for mansoni 20 mg/kg daily for 3 days Oxamniquine: for mansoni 20 mg/kg daily for 3 days

18. Thank you