Schistosomiasis, Group B Presentation-1

GROUP B PRESENTATION
FACULTY OF BASIC MEDICAL SCIENCES

DEPARTMENT OF MEDICINE
NIGER DELTA UNIVERSITY
WILBERFORCE ISLAND
BAYELSA STATE
COURSE TITTLE: ANATOMICAL PATHOLOGY

TOPIC: SCHISTOSOMIASIS
DATE: 30TH JANUARY 2020
LEVEL: 400
GROUP 2
OUTLINE
Introduction
Epidemiology
Life cycle
Pathogenesis
Morphology
Risk factors
Clinical presentation
Laboratory diagnosis
Complications
Treatment
Control
Conclusion
INTRODUCTION
 Schistosomiasis (bilharzia) is a neglected tropical disease
caused by parasitic flatworns (blood flukes) of the genus
schistosoma.
Three species of schistosomes that infect human beings:
Micro organism
• Schistosoma haematobium-perivessical veins
• schistosoma mansoni- inferior mesenteric veins
• Schistosoma japonicum- superior mesenteric veins
• The disease is caused by infection with fresh water parasitic
worms in certain tropical and sub tropical countries. The fresh
water becomes contaminated form infected animal or human
urine or faeces.
• The parasites penetrate human skin to enter the blood stream
and migrate to the liver, intestines and other organs
MODE OF TRANSMISSION
MODE OF TRANSMISSION
Direct contact with contaminated fresh water
where certain types of water snail carry the
worm
INCUBATION PERIOD
2 – 6 weeks after exposure
COMMUNICABILITY
it is not directly transited form person to
person, infective person will release eggs in
urine & faces
EPIDEMIOLOGY
Schistosomiasis infects approximately 200 million person and

kills approximately 280,000 annually.
S.hematobium has been reported in 54 countries and is the
most common species, occurring in sub-Saharan Africa and the
middle test
S.japonicum is endemic in south cast Saia including Philippine
and Thailand

S.japonicum used to be endemic in Japan, but extensive
control efforts led to its elimination in the late 1970’s
S.mansoni is endemic in sub-saharan Africa, Brazil the
Caribbean islands, Puerto rico, Suriname & Venezuela
LIFE CYCLE OF SCHISCOSOME
The parasites life cycle includes two types of
reproduction:
a. asexual reproduction – in snails
b. sexual reproduction – in manuals
ASEXUAL REPRODUCTION-IN SNAILS
 Schistosome life cycle in the snail begins

with the development of miracida into a
sporocyst.
 sporocysts multiply and grow into free
living cercariae
SEXUAL REPRODUCTION-IN MAMMALS
 Cercariae, free living in fresh water, can perpetrate healthy human
skin. The head of the cercariae transforms into an endoparasitic
larva, the schistomule.
 The schistomules passes several days in the skin then enter the
venous circulation and severally migrate to the lungs.
 They then travels through the circulatory system to the
hepatoportal circulation (after 15 days) where they mature into
adult worms and mate.
 Depending on the species, the schistosomes migrate to their final
infection site either on the bladder or the intestine where the female
begin egg production
 The eggs are attached to the wall of the lumen, they penetrate the
walls, they are then expelled in the faeces or urine.
PATHOGENESIS
 Schistosomiasis is due to immunologic reactions to schistosoma eggs
trapped in tissues. Antigens released from the egg stimulate a
granulomatous reaction involving T cells, macrophages, and eosinophils
that results in clinical disease.
 Initially, the inflammatory reaction is readily reversible. T-helper cells
reponse in this early stage is dominated by TH-1 cell and interferon
gamma produced by T-cells. The interferon gamma may stimulate
macrophage to produce high level of pyogens i.e TNF, IL-1 and IL-6
(cytokines that cause fever).
 In the latter stages of the disease, the pathology is associated with
collagen deposition and fibrosis, resulting in organ damage e.g bladder
neck obstruction, anal strictures etc that may be only partially
reversible.
MORPHOLOGY
LIVER
 In several S mansoni and S.japonicum
infection, the surface of the liver is bumpy
caused by discrete granuloma formation,
while the cut surfaces reveals granulomas and
wide spread fibrous portal enlargement
 In patients with Hepatosplenic
schistosomasis, the glomeruli contains
deposits of immunoglobulins and complement
but rarely Schistosome antigen
URINARY BLADDER
 Bladder inflammatory patches due to massive
egg deposition and granulomas appear
healthy and when they erode, they cause
haematuria and the mucosa of the bladder is
hyperaemic and show petchial haemorrhages
 With time, the trigone area become
roughened, raised and discolored. This is also
called SANDY PATCHED LESION
RISK FACTORS
 Poor Sanitation Practice
Excretion of eggs into waters sources used for drinking, bathing, domestic
use etc
 School age children (less immunity)
 Fresh water exposure by swimming or bathing in water containing
infectious cercariae
• occupational exposure through e.g irrigation ditches, rice farming, e.t.c
Particularly in slow-moving water, where the snail hosts con attach to
vegetation
CLINICAL PRESENTATION
 Early manifestation
 Papular skin rash (swimmer’s itch
 Intermediate manifestation (Acute stage)
 Fever
 Malaise
 Cough
 Rash
 Abdominal pain
 Nausea
 Lymphadenopathy
 eosinophilia (katayama fever)
 Chronic manifestations
CONT’D
Bladder
 Dysuria
 Urgency
 Gross hematuria
 secondary UTI
 Non specific pelvic pain
Bowel
 Abdomial pain
 Bloody Diarrhea
DIAGNOSIS
 Gold standard: Eggs in stool of patient
 Intestinal and hepatic schistosomiasis
 Eggs identified in tissue of patient (liver/intestinal biopsy)
 Serology: FAST ELISA
 Urinary Schistosomiaisis
 Eggs in urine or on bladder biopsy
 Fast ELISA
 After Diagnosis: evaluation of ureters, squamous cell
carcinoma
 Skin Biopsy
COMPLICATION
 G.I Bleeding
 G.I Obstruction
 Renal faiture
 Hematuria
 Pyelonephritis
TREATMENT
 praziquantel
 Active against all 3 species
 Works against adult worms
 cure rate 60-90%
 Exact mechanism of action known
 Metrifonate may be used for S.hematobium and Oxamniquine for
S. mansoni as alternative drugs
 Treatment of Complications of Schistosomiasis, e.g cancers,
intestinal diseases
CONTROL
 Isolation of the hospitalized patient; standard
precautions are recommended
 Treatment of Infected population
 Sanitary disposal of human waste
 Public health education about the source of infection
 Travelers to endemic areas should be adviced to
avoid contact with fresh water streams and lakes
 Mass Chemotherapy (praziquantel)
CONCLUSION
Schisostomiasis is an ancient human

disease with effects worldwide,
particularly in the poorest communities.
Effective early treatment is possible,
thereby preventing the substantial
immune mediated effects of schistosoma
infection of human health
REFERENCES
Medical parasitology by DR Arora/Brij Bala Arora- Fourth Edition

Gryseels B, Polman k. Clerinx J. Kestens L. 2006 Human Schistosomiasis, Lancet
368:1106-1118. http://dx.doi.org/10.1016/50140-6736(06)69440-3
WHO . 2013. schistosomiasis progress report 2001-2011 and strategic report 2012-
2020 world Health Organization, Geneva, Switzerland.
www.who.int/iris/bitstream/10665/78074/9789241503174-eng.pdf \
Engels D, Chitsulo L, Montresor A, Savioli L, 2002. The global epidemiological
situation of Schistosomiasis and new approaches to control and research. Act a
trop 82: 139-146

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GROUP B PRESENTATION

FACULTY OF BASIC MEDICAL SCIENCES

COURSE TITTLE: ANATOMICAL PATHOLOGY

Schistosomiasis infects approximately 200 million person and

 Schistosome life cycle in the snail begins

Schisostomiasis is an ancient human

Medical parasitology by DR Arora/Brij Bala Arora- Fourth Edition

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