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Reporter: Ped C. Silvestre
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Introduction
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Acute schitosomiasis:fever,enlargement andtenderness of the liver,eosinophilia,and dysentery
Chronic schitosomiasis : fibro-obstructive lesion
around the portal vessels
Late stage: giant spleen, ascites, hypertension of
portal venous system
Introduction
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The method of disposal of humanexcreta
The presence of the snail intermediatehost
The contact with cercaria-infected
water
Three Major Factors
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s.m
s.j
s.h
OncomelaniaQuadrasi
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Ingestion of
contaminated
water
Contact with
cercaria-infected
water
Poor
sanitation
Endemic areas
Presence of snail
INTERMIDIATE HOST OF CECARIAE
Increased susceptibility
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Penetration of cercariae into the skin
(3 days to reach the capillaries)
Schistosomule enters the bloodstream
(2-3wk old)Schistosomes matures inhepatic portal veins
(LIVER)
(week5)Pair Schistosome migrates and layeggs to other organs
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SCHISTOSOMIASISINTESTINE
(S. Japonicum and S. Mansoni)
BLADDER
(S. Haematobium)
Blood Routine Test:
Acute
stage :eosinophilia is
characteristic
change.WBC raise to
10-30G/L
Chronic
stage:eosinophil
slightly or moderate
rise
Terminal stage: WBC
and platelets are lower
Liver Function Test:
Acute stage: serum
globulin rise, ALT
slightly rise
Chronic stage: most
patients have a normal
liver function,
especially
asymptomatic
Terminal stage: serum
ALB descend caused
by liver cirrhosis
Stool Test :
The discovery of eggsin stool is the evidenceof diagnosis by directsmear or othermethodsImaging test:B-ultrasound: the
degree of liver cirrhosisCT: the image of liverand brainX-ray: chest;esophagus; andgastrointestinal tract
DRUGS:
Praziquantel isthe best choice ofdrug for thetherapy ofschistosomiasis.
Oxamniquine
for S. mansoniMetrifonate forS. haematobium
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The history of contact with schistosome-infectedwater.
Schistosome dermatitis
Incubation period: 23-73 days, average 1 month
Acute Schistosomiasis
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Clinical manifestations come out after 4 to 8 weeksof infection, similar to the time from egg to adult
worm (40 days)
Fever: intermittent, maintain weeks to monthsAllergic reaction:urticaria, angioneuroedema,
enlargement of lymph nodes and eosinophilia
Digestive syndromes: abdominal pain, diarrheawith pus and blood, constipation or diarrhea
Hepatosplenomegaly
Acute Schistosomiasis
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Asymptomatic: most person are asymptomatic Symptomatic: the most common syndrome is
abdominal pain with intermittent diarrhea.
hepatosplenomegaly
Chronic Schistosomiasis
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Liver cirrhosis is the prominent syndrome of this
stage
According to the manifestations , it can be divided
into three types:
The type of giant spleen
The type of ascites
The type of dwarf
Terminal stage of
schistosomiasis
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Schistosomiasis in lungs:found in acute schistosomiasis, by egg deposition.
Symptoms are light and signs are not clear
Schistosomiasis in brain:
Acute type: encephalomeningitis
Chronic type: focal epilepsy
Ectopic Lesion
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Varicosity of esophagus-fundus-
stomach
Hemorrhage of upper gastrointestinaltract
Hepatic encephalopathy (HE)
Spontaneous bacteria peritonitis (SBP)
Complications of LiverCirrhosis
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Appendicitis
Intestinal obstruction and cancroidchange
Complications of intestinal
tract
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Acute schistosomiasis:typhoid fever; amebic liverabscess; tubercular peritonitis; miliary
tuberculosis; bacillary dysentery; malaria;etc.
etiology test and X-ray of chest are diagnostic.Chronic schistosomiasis:anicteric viral
hepatitis;amebic dysentery; chronic bacillary
dysentery;Terminal schistosomiasis: portal liver cirrhosis
and necrosis liver cirrhosis
Differential Diagnosis
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Factors affect the prognosis:
The continuance of infection
The last of pathogenesis
The age of the patients
The complications
Prognosis
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Control of the source of infection:
Treat the patients and domestic animal at the same
time.Cut off the route of transmission:
Snail control
Sanitary disposal of human excreta
Protect of susceptive people:avoid the contact withschistosome-infected water
Prevention