SCHISTOSOMIASIS

(BLOOD FLUKES)

- S. ANAND KUMAR
 INTRODUCTION
- Schistosomes (Blood trematodes) are the
causative agents of the disease ‘Schistosomiasis’.

- Schisto – split ; Soma – body. (Greek)

- Schistosomes are diecious (i.e., the sexes are

separate)
 CLASSIFICATION
- There are 3 species which commonly infect man.
They are: a) Schistosoma hematobium
b) Schistosoma mansoni
c) Schistosoma japonicum

- All the above live in the venous plexus of the

definitive host (man), the location varies with
species.
 LOCATION
TREMATODE HABITAT
1. Schistosoma hematobium In the vesical & pelvic venous
plexuses
2. Schistosoma mansoni In the inferior mesenteric vein
3. Schistosoma japonicum In the superior mesenteric vein
 ETIOLOGY
- Infection to man is by fork-tailed ‘cercariae’
which live in the intermediate hosts – Snails.

- These intermediate hosts live in freshwater

(lakes, canals etc.)

- The intermediate hosts are infected by ‘eggs’

discharged through urine (or) faeces of man into
freshwater.
 PATHOGENESIS
- Definitive host: Human (While bathing in
infected/contaminated water)

- Intermediate host: Snails

- Infective agent: Cercariae (Living in freshwater)

- Portal of entry: Intact/Unbroken skin

- Site of localisation: Peripheral venules

 PATHOGENESIS
Cercariae enters skin of human

They enter peripheral venules

after shedding their tail (Schistosomulae)

Then, they migrate through vena cava

into the right heart, pulmonary circulation,
the left heart and the systemic circulation
 PATHOGENESIS
From there, they enter the portal
circulation and reach the liver

After sexual maturation, they

start migrating against blood stream
into portal system venules of:
a) Urinary bladder – S. hematobium
b) Large intestine – S. mansoni
c) Ileo-caecal region – S. japonicum
 Clinical features
a) Schistosoma hematobium (Urinary)
* On skin penetration: - Pruritic rash & dermatitis
* On laying eggs: - Painless terminal hematuria or
Endemic hematuria.
* Late stages: - Fibrosis & calcification of
adjacent structures of uro-
genital apparatus.
* Chronic cases: - May result in urinary bladder
carcinoma.
 CLINICAL FEATURES
b) Schistosoma mansoni (Intestinal)
* In the large intestine: - Abdominal pain
- Bloody diarrhoea

c) Schistosoma japonicum
* Acute schistosomiasis (or) Katayama fever:
Common in S. mansoni & S. japonicum
infection but rarely occurs in S. hematobium too.
 CLINICAL FEATURES
* Acute schistosomiasis: - High fever
- Hepatosplenomegaly
- Lymphadenopathy
- Dysentery

Complications: - Portal hypertension

- Oesophageal varices
- Cor pulmonale
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