1. ”FIRST AND FINEST” Vaginal Schistosomiasis: A Case That Will Make You Squirm LT Laura Mace, DO LCDR Kristina St.Clair, DO, MTM&H Naval Medical Center Portsmouth

2. ”FIRST AND FINEST” Nothing to disclose The views and opinions expressed herein do not necessarily state or reflect those of the Naval Medical Center Portsmouth, DoD, or the United States Government Disclaimer

3. ”FIRST AND FINEST” Case 22-year-old active duty female routine pap smear –Incidental schistosomiasis eggs Patient born in the United States No travel history outside of the country Asymptomatic and normal exam

4. ”FIRST AND FINEST” Case

5. ”FIRST AND FINEST” Case

6. ”FIRST AND FINEST” Schistosoma egg –Confirmed by Parasitologists: Uniformed Services University Brown University Schistosoma mansoni Falcon Assay –0 units/  l serum (>10 units/  l positive test) One stool for ova and parasite –Negative Case

7. ”FIRST AND FINEST” The Missing Link

8. ”FIRST AND FINEST” 23 year old Active Duty boyfriend –Evaluation in the Infectious Disease Clinic The Missing Link

9. ”FIRST AND FINEST” 23 year old Active Duty boyfriend –Evaluation in the Infectious Disease Clinic Travel History: –South Korea Age 10 for two weeks –Dominican Republic Age 17 for two weeks –Iraq 6 months in 2011 The Missing Link

10. ”FIRST AND FINEST” 23 year old Active Duty boyfriend –Evaluation in the Infectious Disease Clinic Travel History: –South Korea Age 10 for two weeks –Dominican Republic Age 17 for two weeks –Iraq 6 months in 2011 The Missing Link

11. ”FIRST AND FINEST” One stool ova and parasites –Negative A CT abdomen and pelvis Schistosoma mansoni Falcon Assay –7 units/  l serum Permanent change of station soon after evaluation –Contacted for treatment Case

12. ”FIRST AND FINEST” 200 million people infected worldwide Third most devastating tropical disease worldwide –Greater than 200,000 deaths annually 5 species: –S. mansoni –S. haematobium –S. japonicum –S. intercalatum –S. mekongi Schistosomiasis Epidemiology CDC

13. ”FIRST AND FINEST” CDC S. mansoni S. hematobium S. japonicum S. mekongi S. mansoni S. hematobium S. intercalatum Schistosomiasis Epidemiology

14. ”FIRST AND FINEST” A Complex Lifecycle CDC

15. ”FIRST AND FINEST” A Complex Lifecycle Biomphalaria CDC

16. ”FIRST AND FINEST” “Swimmer’s itch” –Minutes to days Katayama Fever: –14 to 84 days Fever General malaise Headache Cough Lymphadenopathy Hepatosplenomegaly Urticaria Arthralgias & myalgias Diarrhea Eosinophilia Clinical Presentation Manson’s Tropical Disease

17. ”FIRST AND FINEST” –Urinary obstruction –Squamous cell carcinoma –Liver fibrosis –Portal hypertension –Ectopic eggs CNS Infertility Morbidity & Mortality: Manson’s Tropical Disease

18. ”FIRST AND FINEST” tmrc.usu.edu

19. ”FIRST AND FINEST” Well described with S. hematobium S. mansoni –Migration of eggs through venous channels between the internal spermatic and mesenteric veins Inflammation Direct gonadotoxic effects Infertility WHO.com Research Journal of Medical Sciences. 2010. African Health Sciences. 2012.

20. ”FIRST AND FINEST” Parasite lifecycle –Real patient Travel history Praziquantel - drug of choice Active Duty male patient treated to avoid potential infertility Question: should certain high risk Active Duty populations be intermittently screened? Key Points

21. ”FIRST AND FINEST” navyseals.com

22. ”FIRST AND FINEST” Thank You

23. ”FIRST AND FINEST” Questions? helenrigden.wordpress.com