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.
 S.mansoni S. haematobium S. japonicum
Type &
S.mekongi
Disease
Intestinal urinary intestinal
schistosomiasis schistosomiasis schistosomiasis

Epidemio- South America , Africa Far east → japonicum

Africa, and Middle &
logy East → S.mansoni Southeast Asia→ mekongi
the Middle East
West Africa →
S. intercalatum
Egg

lateral spine spherical egg

video
 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

 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
•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.
 Urine and stool samples:
we detect schistosomal eggs in the urine or stool
using a microscope.

 Blood tests:
1- PCR testing (detection of schistosomal DNA)
2- Blood serology (antibodies against Schistosomiasis)

 Chest X-ray:
if the lungs are affected.
 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 long, thin flexible instrument that provides magnified views
of the colon and rectum.) or
cystoscopy (looking inside the bladder
with a cyctoscope).
 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 parasitic 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
.

Adults and children 1 year of age and older:

20 mg/kg orally three times per day for 1 day, every 4-6 hours
Is an organophosphorus compound (OPC)that acts by inhibiting
cholinesterase enzyme → paralyzing the worm.

➢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:
1. Epileptiformconvulsions (especially in patients with a history of
convulsive disorders)
1. Oxamniquine should not be taken during pregnancy
 Complications of schistosomiasis
1. Chronic liver damage and an enlarged spleen

2. Colon ( or large intestine) inflammation

3. Kidney and bladder obstruction

4. Pulmonary hypertension

5. Repeated blood infections (bacteria can easily enter the

bloodstream through an inflamed colon)

6. Seizures

7. Bladder cancer
✓Are extremely dilated
sub-mucosal veins in the
esophagus mainly due to portal
hypertension
✓It may rupture causing life-
threatening bleeding.
 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

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