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Blood Trematodes
Isna IndrawatiDepartment of Parasitology
SCHISTOSOMA JAPONICUM SCHISTOSOMA MANSONI SCHISTOSOMA MEKONGISCHISTOSOMA INTERCALATUMSCHISTOSOMA HAEMATOBIUM
Schistosoma
WHO fact sheet (2012) :230 million infected people are require
treatment yearly.Schistosomiasis transmission has been
documented in 77 countries.90% of those requiring treatment for
schistosomiasis live in Africa.In sub-Saharan Africa: > 200 000 deaths
per year are due to schistosomiasis.
Schistosoma
Belongs to Platyhelminthes.Have separate sexes. Live in venule of mesenteric / plexus
vesicalisRequire one intermediate host to
complete their life cycleLife cycle and pathological effect nearly
the same
Species Geographical distribution
Intestinal schistosomiasis Schistosoma mansoni
Africa, the Middle East, the Caribbean, Brazil, Venezuela, Suriname
Schistosoma japonicum China, Indonesia, the Philippines
Schistosoma mekongiSeveral districts of Cambodia and the Lao People’s Democratic Republic
Schistosoma guineensis and related S. intercalatum
Rain forest areas of central Africa
Urogenital schistosomiasis
Schistosoma haematobium Africa, the Middle East
S.Japonicum S. mansoni S. haemato
bium
Distribution
Asia: China, Indonesia, the Philippines
Africa, South America
DiseaseOriental Schist.is Katayama disease, snail fever
Manson’s intestinal schist. is
Definitive Host
Human, dog, cat, rat, cattle ect.
Human, Monkey
Intermediate host
Oncomelania Biomphalaria
Habitat V. Mesenterica superior V. Mesenterica inferior
OnchomelaniaBiomphalaria
S. mansoni
S.Japonicum S. mansoni S.haematobium
Adult:- Male- female
1.2 – 2 cm2.6 cm
0.6 – 1.2 cm1.2 – 1.7 cm
Body surface The cuticle of the
male is covered with fine spines
The cuticle of the male is covered with minute papillae.
Testes 7 testes 6-9 testes
Eggs 70-100 x 50-65 µ , oval, lateral knob
114-175x 45-68 µ, elongate, lateral spine
Pathogenesis and clinical symptoms
Infection : penetration of cercaria through the skin pruritic skin rash (swimmer's itch within 24 hours post infection
During incubation period: General : malaise, headache, nauseaAllergic rx to metabolite : urticaria ,
angio-neurotic edema, feverLung: cell infiltration and haemorrhage
Cercarial / swimmers’s itch
Clinical symptoms
Acute : usually 4-8 weeks after contact with infested water
Fever , fatigueabdominal pain, When egg deposition : gastro intestinal
complaints, diarrhoea (dysentery).Symptoms : >> are caused by the
body's reaction to the worms’ eggs
Adult worms may produce 300 to 3000 eggs per day.
Many of the eggs pass through the intestinal wall into the feces.
carried in blood and become trapped in, gastro-intestinal, the liver , lungs and brain etc.
Eggs of Schistosoma trapped in the intestinal wall and liver
eggs that carried in bloodtrapped in liver, lungs, and brain
rx granuloma surrounding eggs
pseudo tubercle in the liver / organs
fibrosis
Chronic :
90 % patients are in chronic stage. weakness, fatigue, abdominal pain Liver enlargement Portal hypertension of the abdominal
blood vessels.Splenomegali
Occasionally central nervous system lesions occur: cerebral granulomatous disease may be caused by ectopic S. japonicum eggs in the brain,
Ascites : an accumulation of fluid in the peritoneal cavity
Source : twmrf.com
Terminal / late stage :
Cirrhosis Abdominal collateral vein dilatation ,
oesopahago-gastric variceslower limb edema, hematemesis, and melena
DIAGNOSIS
detection of parasite eggs in stool or tissues biopsy
In chronic stage: difficult to find eggs in the stool
serological/ immunological test : may be useful in the detection of infection.
Diagnosis (cont’d)
Elisa, COPT, IHA
COPT
Epidemiology
People are at risk of infection : activities which expose them to infested water.
Prevention and Control : preventive treatment snail control, improved sanitation health education
Epidemiology (cont’d)
In Indonesia : endemic in Danau Lindu and Lembah Napu, Central of Sulawesi
Integrated control started in year 2000, ( mass treatment and snail control
Mass treatment using praziquantel was held every 6 months.
Epidemiology (cont’d)
Difficult in controlling the disease : zoonotic disease ( prevalence in Rattus spp. 0 to 20% )
in Indonesia : transmission still occured in 2006 : prevalence 0.49% in Danau
Lindu and 1.08% in Lembah Napu ( in1973: 73 %)
Epidemiology (cont’d)
needs for power and water, often result in environmental modifications
Treatment should be complemented with health education, as well as access to safe water and good sanitation.
Thank you