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Trematode infections
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Pratap Sagar Tiwari
Rajeev Shah
Prakash Naag
Residents, Internal Medicine, NGMC
TREMATODE INFECTIONS
TOPICS
• Introduction
• Classification
• Life cycle
• Clinical manifestaions
• Investigations
• Management
MAJOR HUMAN TREMATODE INFECTIONS
Blood flukes Liver flukes
Schistosoma mansoni
S. Japonicum
S. Intercalatum
S. Mekongi
S. Haematobium
Clonorchis sinensis
Opisthorchis viverrini
O. Felineus
Faciola hepatica
F. gigantica
Intestinal flukes Lung flukes
Fasciolopsis buski Paragonimus westermani
LIFE CYCLE OF SCHISTOSOMAS
CLINICAL MANIFESTATIONS: SCHISTOSOMIASIS
Acute manifestations
• Cercarial dermatitis (summer’s itch):is an allergic reaction caused by the
penetration of cercariae in persons who have been exposed to cercariae in
salt water or fresh water.
• Swimmer’s itch most often occurs in S .mansoni and S. japonicum.
• Manifested as petechial hemorrhage with edema and pruritus followed by
maculopapular rashes and sometimes vesicular.
• It is self limiting
CLINICAL MANIFESTATIONS: SCHISTOSOMIASIS
Acute manifestations
• Katayama syndrome: This syndrome is caused by high worm load and egg
antigen stimuli that result from immune complex formation and leads to a
serum sickness–like illness.
• This is the most severe form and is most common in persons with S
mansoni and S japonicum infections.
• Symptoms include high fever, chills, headache, hepatosplenomegaly,
lymphadenopathy, eosinophilia, and dysentery.
CLINICAL MANIFESTATIONS: SCHISTOSOMIASIS
Chronic manifestations
• Symptoms depend on the Schistosoma species that causes the infection, the
duration and severity of the infection, and the immune response of the host
to the egg antigens.
• Terminal hematuria, dysuria, and frequent urination .
• The earliest bladder sign is pseudotubercle, but, in longstanding infection,
radiography reveals nests of calcified ova (sandy patches) surrounded by
fibrous tissue in the submucosa.
CNS SCHISTOSOMIASIS
• Headache, seizures (both generalized and focal), myeloradiculopathy with
lower limb and back pain, paresthesia, and urinary bladder dysfunction are
the noted symptoms of CNS schistosomiasis due to S japonicum infection.
• Neuroschistosomiasis is a severe manifestation of schistosomal infection.
The neurological symptoms result from the inflammatory response of the
host to the deposition of eggs in the brain and spinal cord.
• Myelopathy is the most common neurological complication of S.
mansoni infection.
SUMMARY OF MANIFESTATIONS
Organisms Symptoms
Blood flukes
S. mansoni, S. japonicum Dermatitis, abdominal pain, bloody stool, peri-portal
fibrosis, hepato-splenomegaly, ascites, CNS
Schistosoma hematobium Dermatitis, urogenital cystitis, urethritis and bladder
carcinoma
Liver flukes
C. sinensis,
O. felinus, or O. viverini
Inflammation and deformation of bile duct, hepatitis,
anemia and edema
Fasciola hepatica fever, anemia, hepatobiliary manifestations (colicky pain,
jaundice), and secondary bacterial infections are present.
SUMMARY OF MANIFESTATIONS
Intestinal flukes
Fasciolopsis buski Epigastric pain, nausea, diarrhea, edema, ascites
Lung flukes
Paragonimus
westermani
Cough (dry / rusty brown sputum), pulmonary pain,
pleurisy, tuberculosis-like features.
SCHISTOSOMIASIS
Investigation, Diagnosis and
Management
INVESTIGATION /DIAGNOSIS
• Blood:PBS
• Microscopy:stool/urine/sputum
• Serology: detecting antibodies/antigens
• Imaging
TREATMENT
PREVENTION
• Information, education and communication on safe food practices.
• Improved sanitation, aimed at decreasing contamination of freshwater
streams with human faeces.
• Control or containment of the intermediate snail hosts.
• Preventive chemotherapy ??
• Vaccination ??
TREMATODES INFECTION IN NEPAL
• Includes Fasciola spp., and Schistosoma spp. (Patz et al. 2000, Dobson et
al. 2003, Mas-Coma et al. 2009)
• The highest prevalence of infection (38.3%) was recorded among snails (I.
exustus)collected from temporary ponds in chitwan.(Devkota et al 2008)
• 1.7% infection rate of Fasciola sp. larvae in Lymnaea sp. of snail from Kavre,
Nepal (Pandey 2001)
• 3.52% rate of patent trematode infections in Chitwan and Nawal parasi
districts of Nepal (Devkota et al 2008).
Thankyou
References:• Harrison’s principles of internal medicine 18h ed
• Davidson Principles & Practice of medicine
• Uptodate 19.3
• Emedicine.com last update sept 2012
WATERCRESS /SIM RAYO
WATER CHESTNUTS/ MAKHAN
LIFE CYCLE OF SCHISTOSOMAS
LIFE CYCLE OF INTESTINAL FLUKES
LIFE CYCLE OF LUNG FLUKES :PARAGONIMUS
• Thankyou