i presented this lecture to members of the ghana medical association ternopil branch, ukraine

1. SCHISTOSOMIASIS/
BILHARZIOSIS
BY:
INUSAH ADAMS
4th yr med. Student
TDMU, Ukraine
DEC, 1ST, 2012
TDMU

2. Bilhazia in Ghana

3. PLAN OF PRESENTATION
 DEFINITION
 EPIDEMIOLOGY
 ETIOLOGY
 MODE OF TRANSMISSION/LIFE CYCLE
 PATHOGENESIS
 SIGNS &SYMPTOMS
 DIAGNOSIS
 DIFFERENTIALS
 TREATMENT
 COMPLICATIONS
 PROGNOSIS

4. DEFINITION
• Schistosomiasis is a chronic, parasitic
disease caused by blood flukes
(trematode worms) of the genus
Schistosoma
• Also, called snail fever

5. EPIDEMEOLOGY
The disease is found in Africa, South
America, East Asia and Middle East
Over 230 million people require
treatment for schistosomiasis yearly
90% of those requiring treatment for
schistosomiasis live in Africa.
More than 200,000 deaths per year
are due to schistosomiasis in sub-
Saharan Africa

6. ETIOLOGY
• Parasitic worms of schistosoma species
Main species are;
a. Schistosoma haematobium
b. Schistosoma mansoni
c. S. japonicum
d. S. mekongi and
e. S intercalatum

7. Two forms of schistosomiasis exist
1. Intestinal schistosomiasis and
2. Urogenital schistosomiasis

8. SCHISTOSOMA MANSONI (lateral spine)

9. SCHISTOSOMA HAEMATOBIUM(terminal spine)
• TT

10. RISK FACTORS
• wading or swimming in lakes, ponds and
other bodies of water which are infested
with the snails
• Fishing (both men and women)
• Women washing clothes in infested water
are at risk
• People with STIs

11. LIFE CYCLE
• : parasite eggs are released(by way of urination
or defecation) into the environment from infected
individuals.
• The eggs hatch on contact with fresh water to
release the free-swimming miracidium
• Miracidium penetrates a water snail tissue where
it develops into cercaria
• Cercaria is release into the water from the snail
• cercaria penetrates the skin of human (definitive
host), circulate to organs (GIT, urinary tract)

13. LIFE CYCLE

14. LIFE CYCL con’t

16. Schistosoma dermatitis or “swimmers itch”

17. 1.
PATHOGENESIS forms of the
People become infected when larval
parasite – released by freshwater snails – penetrate
their skin during contact with infested water.
2. the larvae develop into adult schistosomes
3. Adult schistosomes live in the blood vessels where
the females release eggs
4. Some of the eggs are passed out of the body in the
faeces or urine to continue the parasite life-cycle
5. Others become trapped in body tissues (intestinal
and urinary system), causing an immune reaction
and progressive damage to organs.

18. SIGNS & SYMPTOMS
• Clinical picture: low grade fever. Fatigue, weight loss and
anemia
• INTESTINAL SCHISTOSOMIASIS
1. Abdominal pain
2. Diarrhea
3. Blood in stool, fresh or melena
4. Hematemesis
5. Liver enlargement
UROGENITAL SCHISTOSOMIASIS
1. Hematuria (terminal)
2. dysuria
3. Frequent need to urinate (polykauria)
4. In females; genital lesions, vaginal bleeding, pain during
sexual intercourse and nodules on the vulva, irregular
menstruation

19. DIFFERENTIAL DIAGNOSIS
UROGENITAL SCHISTOSOMIASIS
• Renal tuberculosis ("golf-hole" (gaping) ureteral orifice is seen
during cystoscopy, Yellow raised nodules) surrounded by a
halo of hyperemia in bladder)
• Urogenital tract cancer ( total hematuria, hematuria may stop
and recur in a week, month or year time)
• Urolithiasis (colicky pain)
INTESTINAL SCHISTOSOMIASIS
• Peptic ulcer disease (heartburns, GERD,
endoscopically, ulcer in GIT)
• Pancreatitis (H-like pain, vomiting that is worsened with
eating, high diastase level, etc.)
• cutaneous leishmaniasis (non-healing raised, scaling lesions on
the skin)

20. DIAGNOSTIC PLAN
1. stool examination for S. mansoni and ova
2. Urinalysis and urine for S. hematobium and ova
3. General blood analysis:
4. Serological: hemagglutination test; reaction is positive @ a
dilution of 1: 16 or more
5. BUN and creatinine level
6. Ureterocystoscopy
7. Biopsy of rectum or urinary bladder
8. Plain abdominal X-ray: chronic cases may show calcification
and fibrosis of ureters, urinary bladder, ascites
9. Intravenous urography: may show the level of ureter stricture
10. Ultrasound of abdomen: hepatosplenomegaly, bilharzial
hepatic fibrosis, ascites

21. clusters of the parasite eggs with
intense eosinophilia

22. Calcification of the urinary bladder

25. Yellow raised nodules surrounded by a
halo of hyperemia (TB of bladder)

26. Cystoscopy in tumor of kidney
(gross hematuria)

27. TREATMENT
• Drug: Prazequnatel
Dose: 40mg/kg single oral dose
60mg/kg in 2 divided doses if
quantity of ova is high
Review in 2 weeks

28. Urogenital schistosomiasis
1. cystitis
2. Urinary bladder cancer
3. Polyps, ulcers of urinary bladder
4. Hemospermia
5. Infertility
6. Spontaneous abortion
7. Renal failure
8. anemia
Intestinal schistosomiasis
1. Liver fibrosis
2. Intestinal cancer
3. Portal hypertension/Pulmonary hypertension/ Cor pulmonale
4. Ascites
5. Esophageal varices
6. Malnutrition
COMPLICATIONS

29. • Always good especially with prompt
diagnosis and treatment
PROGNOSIS

30. PREVENTION
Education
Eliminating the water-borne snails which are
natural reservoirs for the disease
Annual dose of prazequantel
adding niclosamide, acrolein, copper sulfate, etc.,
to the water sources in order to kill the snails.
Avoid swimming and contact with fresh water in
endemic areas
Boiling water for 1 minute will kill the parasite.
(Filtration of drinking water )

31. • GHANA AND BILHARZIA