1. Schistosomiasis presented by Dr. Magdy Awny

2. Schistosomiasis (bilharzia, bilharziasis , snail fever)
parasitic disease caused by blood flukes of the
class Trematoda.
Theodore Bilharz identified the parasite
S. hematobium in Egypt in 1851
Schistosomiasis is the second most prevalent
tropical disease in the world; malaria is the first.
The disease is found mainly in developing
countries in Africa, Asia, South America and
the Middle East.

3. Types of schistosoma Type S. haematobium S. japonicum & S.mekongi
S.mansoni
 Type
intestinal schistosomiasis
urinary
schistosomiasis
Intestinal
Disease
Far east → japonicum
Southeast Asia→ mekongi
Africa
the Middle East
South America , Africa, and Middle East → S.mansoni
West Africa →
S. intercalatum
Epidemio-
logy
spherical egg
terminal spine
lateral spine
Egg

4. Life cycle of schistosoma
video

5. Symptoms
Dermatitis (itching) due to penetration of cercariae the human skin
S. haematobium infection symptoms of the bladder are:
1- pain during urination
2- frequent need to urinate
3- blood in the urine

6. S. mansoni infection symptoms of the intestines are:
1-Abdominal pain
2-Bloody diarrhea
3-Abdomen may be swollen due to enlargement of the liver
A blood test usually reveals signs of anemia

7. A 45-year-old, Egyptian male presented with severe hematemesis caused by esophageal varices. The patient had been a heavy smoker for 30 years, with no significant illness in the past. There was no organomegaly. Laboratory findings revealed elevated liver enzymes and positivity for hepatitis C infection. Abdominal ultrasound revealed mild hepatic cirrhosis. Stool examination for schistosome ova was positive for Schistosoma mansoni. ELISA for schistomiasis infection was also performed with serum, which showed high levels of antibodies to Schistosoma mansoni. Endoscopic sclerotherpy was used to sclerose his bleeding varices. For schistomiasis treatment, the patient received praziquantel 40 mg/kg in a single dose. The patient recovered successful during the next few days and was discharged from the hospital.

8. Diagnosis Urine and stool samples: Blood tests: Chest X-ray:
Detects schistosomal eggs in the urine or stool
using a microscope.
Blood tests:
1- PCR testing (detection of schistosomal DNA)
2- Blood serology (antibodies against shistosomiasis)
Chest X-ray:
if the lungs are affected.

9. Diagnosis
Scans:
An ultrasound scan of the liver or the heart to see if they
are infected or not
CT or MRI scanning is used, especially if the brain or
spinal cord is affected.
Colonoscopy or cystoscopy:
Taking samples at colonoscopy (looking inside the bowel
with a telescope) or
cystoscopy (looking inside the bladder
with a telescope).

10. Drugs used for treatment
Praziquantel (Biltricide):
 induces ultrastructural changes in the teguments of adult
worms, →↑ permeability to calcium ions.→↑ Calcium
ions in the parasite cytosol → muscular contractions,
paralysis of adult worms.
By damaging the tegument membrane, praziquantel also
exposes parasite antigens to host immune responses.
These effects lead to dislodgement of worms from their
intestinal sites.
WHO-recommended single dosage of 40 mg/kg has shown it to be safe
and relatively efficacious .

11. Metrifonate (Bilarcil)
Is an organophosphorus compound that acts
by inhibiting cholinesterase enzyme →
paralyzing the worm.

12. Oxamniquine (Vansil)
Irreversible inhibition of the nucleic acid metabolism of the parasites.
The drug is activated by a single step, in which a schistosome
sulfotransferase enzyme converts oxamniquine into an ester
form, this electrophilic reactant is capable of alkylation of
schistosome DNA.
Side effect:
Epileptiform convulsions (especially in patients with a history of
convulsive disorders)
Oxamniquine should not be taken during pregnancy

13. Complications of schistosomiasis
Chronic liver damage and an enlarged spleen
Colon ( or large intestine) inflammation
Kidney and bladder obstruction
Pulmonary hypertension
Repeated blood infections (bacteria can easily enter the
bloodstream through an inflamed colon)
6. Seizures
7. Bladder cancer

14. Esophageal Varices Are extremely dilated sub-mucosal veins in the
esophagus mainly due to portal
hypertension
It may rupture causing life-
threatening bleeding.

15. Sclerotherapy Is a procedure used to treat blood vessel
malformations (vascular malformations).
A medicine is injected into the vessels, which
makes them shrink. to stop bleeding from
varicose veins and hemorrhoids.
e.g. hypertonic saline, ethanolamine,
polidocanol and sodium tetradecyl sulfate

16. prevention

17. Prevention Avoid swimming or bathing in contaminated water
Medications to prevent schistosomiasis
drinking bottled water when traveling to endemic areas
B-snail control: by using molluscicide e.g. Cu SO4 ,
quick lime
there is no vaccine available for schistosomiasis

18. Thank you