Schistosomiasis history and symptoms: Difference between revisions

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{{Schistosomiasis}}
{{Schistosomiasis}}
{{CMG}}
{{CMG}} ; {{AE}} {{ADG}}


==Overview==
==Overview==
Many infections are subclinically symptomatic, with mild anemia and malnutrition being common in endemic areas. Acute schistosomiasis (Katayama's fever) may occur weeks after the initial infection, especially by ''S. mansoni'' and ''S. japonicum''.
The majority of patients with schistosomiasis in early phase are [[asymptomatic]], unless [[katayama fever]], an acute [[immune complex]] [[disease]], occurs. Late schistosomiasis is [[symptomatic]] and includes hepatosplenic schistosomiasis ([[Portal hypertension|presinusoidal portal hypertension]]), [[urinary]] and [[urogenital]] schistosomiasis ([[urinary obstruction]], [[genital]] symptoms), schistosomal [[glomerulopathy]] (chronic immune complex deposition in the [[kidney]]), and ectopic [[disease]] in areas such as the [[lungs]] and [[central nervous system]] (CNS).


==History==
==History==
The significant information that needs to focused in the history of the patient includes  
The significant information that needs to focused in the history of the patient includes  
*Any history of travel to the endemic areas
*Any [[History & Symptoms|history]] of travel to the endemic areas
*Any ill contact with similar complaints
*Any ill contact with similar complaints
==Symptoms==  
==Symptoms==  
Clinical manifestations of schistosomiasis can be divided into schistosome dermatitis, acute schistosomiasis (Katayama fever), and chronic schistosomiasis.<ref name="pmid21586478">{{cite journal |vauthors=Gray DJ, Ross AG, Li YS, McManus DP |title=Diagnosis and management of schistosomiasis |journal=BMJ |volume=342 |issue= |pages=d2651 |year=2011 |pmid=21586478 |pmc=3230106 |doi= |url=}}</ref>
Clinical manifestations of schistosomiasis can be divided into:
* Schistosome dermatitis
* Acute schistosomiasis (katayama fever)
* Chronic schistosomiasis<ref name="pmid21586478">{{cite journal |vauthors=Gray DJ, Ross AG, Li YS, McManus DP |title=Diagnosis and management of schistosomiasis |journal=BMJ |volume=342 |issue= |pages=d2651 |year=2011 |pmid=21586478 |pmc=3230106 |doi= |url=}}</ref>
 
===Acute schistosomiasis(Katayama fever)===
===Acute schistosomiasis(Katayama fever)===
*Acute schistosomiasis occurs 20 to 50 days after primary exposure.<ref name="pmid7676521">{{cite journal |vauthors=Jensen T, Rønne-Rasmussen JO, Bygbjerg IC |title=[Acute schistosomiasis (Katayama fever)] |language=Danish |journal=Ugeskr. Laeg. |volume=157 |issue=35 |pages=4825–7 |year=1995 |pmid=7676521 |doi= |url=}}</ref><ref name="pmid8898604">{{cite journal |vauthors=Doherty JF, Moody AH, Wright SG |title=Katayama fever: an acute manifestation of schistosomiasis |journal=BMJ |volume=313 |issue=7064 |pages=1071–2 |year=1996 |pmid=8898604 |pmc=2352353 |doi= |url=}}</ref><ref name="pmid21887064">{{cite journal |vauthors=Baharoon S, Al-Jahdali H, Bamefleh H, Elkeir A, Yamani N |title=Acute pulmonary schistosomiasis |journal=J Glob Infect Dis |volume=3 |issue=3 |pages=293–5 |year=2011 |pmid=21887064 |pmc=3162819 |doi=10.4103/0974-777X.83539 |url=}}</ref>
*Acute schistosomiasis occurs 20 to 50 days after primary exposure.<ref name="pmid7676521">{{cite journal |vauthors=Jensen T, Rønne-Rasmussen JO, Bygbjerg IC |title=[Acute schistosomiasis (Katayama fever)] |language=Danish |journal=Ugeskr. Laeg. |volume=157 |issue=35 |pages=4825–7 |year=1995 |pmid=7676521 |doi= |url=}}</ref><ref name="pmid8898604">{{cite journal |vauthors=Doherty JF, Moody AH, Wright SG |title=Katayama fever: an acute manifestation of schistosomiasis |journal=BMJ |volume=313 |issue=7064 |pages=1071–2 |year=1996 |pmid=8898604 |pmc=2352353 |doi= |url=}}</ref><ref name="pmid21887064">{{cite journal |vauthors=Baharoon S, Al-Jahdali H, Bamefleh H, Elkeir A, Yamani N |title=Acute pulmonary schistosomiasis |journal=J Glob Infect Dis |volume=3 |issue=3 |pages=293–5 |year=2011 |pmid=21887064 |pmc=3162819 |doi=10.4103/0974-777X.83539 |url=}}</ref>
*[[Malaise]], [[diarrhea]], [[weight loss]], [[cough]], [[dyspnea]], [[chest pain]], restrictive respiratory insufficiency, and [[pericarditis]] are important symptoms of acute schistosomiasis.
*Presents with [[malaise]], [[diarrhea]], [[weight loss]], [[cough]], [[dyspnea]], [[chest pain]], restrictive respiratory insufficiency, and [[pericarditis|pericarditis.]]
*Mild disease resolves on its own, as the infection progress into an asymptomatic phase, which is often misinterpreted for an effective antibiotic therapy.
*The clinical syndrome (i.e., [[fever]], [[chills]], [[liver]] and [[spleen enlargement]], and marked [[eosinophilia]]) is specific for [[Schistosoma japonicum|<nowiki>''</nowiki>S. ''japonicum''<nowiki>''</nowiki>]] infection.
*The clinical syndrome (i.e., [[fever]], [[chills]], [[liver]] and [[spleen enlargement]], and marked [[eosinophilia]]) is specific for [[''Schistosoma japonicum'']] infection.
*Acute disease is not observed in individuals living in endemic areas of schistosomiasis because of the down-modulation of the [[immune response]] by [[antigens]] or idiotypes transferred from mother to child.
*Acute disease is not observed in individuals living in endemic areas of schistosomiasis because of the down-modulation of the immune response by antigens or idiotypes transferred from mother to child.


===Chronic schistosomiasis===
===Chronic schistosomiasis===
====Intestinal schistosomiasis====
'''Intestinal schistosomiasis'''
*In chronic schistosomiasis [[abdominal pain]], [[irregular bowel movements]], and [[blood in the stool]] are the main symptoms of intestinal involvement.
*Colonic polyposis may occur.<ref name="pmid18322031">{{cite journal |vauthors=King CH, Dangerfield-Cha M |title=The unacknowledged impact of chronic schistosomiasis |journal=Chronic Illn |volume=4 |issue=1 |pages=65–79 |year=2008 |pmid=18322031 |doi=10.1177/1742395307084407 |url=}}</ref><ref name="pmid16394292">{{cite journal |vauthors=Mourra N, Lesurtel M, Paye F, Flejou JF |title=Chronic schistosomiasis: an incidental finding in sigmoid volvulus |journal=J. Clin. Pathol. |volume=59 |issue=1 |pages=111 |year=2006 |pmid=16394292 |pmc=1860253 |doi= |url=}}</ref>
*Hepatosplenic involvement is the most important cause of morbidity with S. mansoni and S. japonicum infection.
*Patients may remain asymptomatic until the manifestation of hepatic fibrosis and portal hypertension develops.
*Hepatic fibrosis is caused by a granulomatous reaction to Schistosoma eggs that have been carried to the liver.
*Hematemesis from bleeding esophageal or gastric varices may occur.
**In such cases, anemia and decreasing levels of serum albumin are observed. Some patients have severe hepatosplenic disease with decompensated liver disease. Jaundice, ascites, and liver failure are then observed.
*Concomitant infection by Salmonella species, and less extensively by other gram-negative bacteria, with S. mansoni or S. haematobium leads to a picture of prolonged fever, hepatosplenomegaly, and mild leukocytosis with eosinophilia.


====Schistosomal nephropathy====
*In chronic schistosomiasis [[abdominal pain]], [[irregular bowel movements]], and [[blood in the stool]] are the main symptoms of intestinal involvement.<ref name="pmid18322031">{{cite journal |vauthors=King CH, Dangerfield-Cha M |title=The unacknowledged impact of chronic schistosomiasis |journal=Chronic Illn |volume=4 |issue=1 |pages=65–79 |year=2008 |pmid=18322031 |doi=10.1177/1742395307084407 |url=}}</ref><ref name="pmid16394292">{{cite journal |vauthors=Mourra N, Lesurtel M, Paye F, Flejou JF |title=Chronic schistosomiasis: an incidental finding in sigmoid volvulus |journal=J. Clin. Pathol. |volume=59 |issue=1 |pages=111 |year=2006 |pmid=16394292 |pmc=1860253 |doi= |url=}}</ref>
*Fatigue and asthenia
*Hepatosplenic involvement is the most important cause of [[morbidity]] with [[Schistosoma mansoni|S. mansoni]] and [[Schistosoma japonicum|S. japonicum]] infection.
*Glomerulonephritis
*Patients may remain [[asymptomatic]] until the manifestation of [[hepatic fibrosis]] and [[portal hypertension]] develops.
*[[Hepatic fibrosis]] is caused by a granulomatous reaction to Schistosoma eggs that have been carried to the [[liver]].
*[[Hematemesis]] from bleeding esophageal or gastric varices may occur.
*Concomitant infection by [[Salmonella]] species is observed.


====Pulmonary schistosomiasis====
'''Schistosomal nephropathy'''
*Patients with schistosomal [[nephropathy]] present with [[fatigue]] and [[asthenia]].
*[[Glomerulonephritis]] is also found in untreated [[schistosomiasis]].
 
'''Urogenital schistosomiasis'''
* Patients with [[urogenital]] schistosomiasis present with genital pain, [[pelvic pain]], [[coital bleeding]], and [[dyspareunia]].
'''Pulmonary schistosomiasis'''
*Patients with acute pulmonary schistosomiasis present with [[wheezing]], [[cough]], and [[fever]].  
*Patients with acute pulmonary schistosomiasis present with [[wheezing]], [[cough]], and [[fever]].  
*Patients with chronic pulmonary schistosomiasis experience [[dyspnea]] on exertion, [[fatigue]], and [[hemoptysis]].
*Patients with chronic pulmonary schistosomiasis experience [[dyspnea]] on exertion, [[fatigue]], and [[hemoptysis]].
*Pulmonary hypertension, which used to be exclusively linked to the hepatosplenic form of the disease, has been documented in patients without liver fibrosis.
*[[Pulmonary hypertension]], which used to be exclusively linked to the hepatosplenic form of the disease, has been documented in patients without [[Hepatic fibrosis|liver fibrosis]].


====CNS====
'''Neuroschistosomiasis'''
*In hospitalized adult patients with S. japonicum infection, cerebral schistosomiasis occurs in 1.7 to 4.3%.   
*In hospitalized adult patients with ''[[Schistosoma japonicum|S. japonicum]]'' infection, cerebral schistosomiasis occurs in 1.7 to 4.3%.   
*It may occur as early as 6 weeks after infection, and the most common sign is focal jacksonian epilepsy.  
*It may occur as early as 6 weeks after infection, and the most common sign is focal jacksonian epilepsy.  
*Signs and symptoms of generalized encephalitis may occasionally be found. In S. mansoni infection, neurologic involvement is rare and mainly characterized by transverse myelitis, which occurs mainly in patients without liver fibrosis and hepatosplenomegaly.
*Signs and symptoms of generalized [[encephalitis]] may occasionally be found.  
*In [[Schistosoma mansoni|''S. mansoni'']] infection, neurologic involvement is rare and mainly characterized by [[transverse myelitis]], which occurs mainly in patients without liver fibrosis and [[hepatosplenomegaly]].
 
===Schistosome dermatitis===
===Schistosome dermatitis===
*Schistosome dermatitis, or swimmer's itch, is an uncommon manifestation seen mainly when avian cercariae penetrate the skin and are destroyed.<ref name="pmid14886855">{{cite journal |vauthors=MILLER MJ, MUNROE E |title=Schistosome dermatitis in Quebec |journal=Can Med Assoc J |volume=65 |issue=6 |pages=571–5 |year=1951 |pmid=14886855 |pmc=1822311 |doi= |url=}}</ref><ref name="pmid2670374">{{cite journal |vauthors=González E |title=Schistosomiasis, cercarial dermatitis, and marine dermatitis |journal=Dermatol Clin |volume=7 |issue=2 |pages=291–300 |year=1989 |pmid=2670374 |doi= |url=}}</ref>
*Schistosome dermatitis, or swimmer's itch, is an uncommon manifestation seen mainly when avian [[Cercaria|cercariae]] penetrate the skin and are destroyed.<ref name="pmid14886855">{{cite journal |vauthors=MILLER MJ, MUNROE E |title=Schistosome dermatitis in Quebec |journal=Can Med Assoc J |volume=65 |issue=6 |pages=571–5 |year=1951 |pmid=14886855 |pmc=1822311 |doi= |url=}}</ref><ref name="pmid2670374">{{cite journal |vauthors=González E |title=Schistosomiasis, cercarial dermatitis, and marine dermatitis |journal=Dermatol Clin |volume=7 |issue=2 |pages=291–300 |year=1989 |pmid=2670374 |doi= |url=}}</ref>
*Schistosome dermatitis is a sensitization phenomenon occurring in previously exposed persons.  
*Schistosome dermatitis is a sensitization phenomenon occurring in previously exposed persons.  
*The cercariae evoke an acute inflammatory response with edema, early infiltration of neutrophils and lymphocytes, and later invasion of eosinophils.  
*The cercariae evoke an acute [[Inflammatory response|inflammatory respons]]<nowiki/>e with [[edema]], early infiltration of [[neutrophils]] and [[lymphocytes]], and later invasion of [[eosinophils]].  
*A pruritic papular rash occurs within 24 hours after the penetration of cercariae and reaches maximal intensity in 2 to 3 days.
*A [[Itch|pruritic papular rash]] occurs within 24 hours after the penetration of cercariae and reaches maximal intensity in 2 to 3 days.


'''The table below summarizes the symptoms of schistosomiasis'''
'''The table below summarizes the symptoms of schistosomiasis'''
Line 57: Line 63:
(Katayama fever)
(Katayama fever)
|
|
* Fever
* [[Fever]]
* Malaise
* [[Malaise]]
* Arthralgia/myalgia
* [[Arthralgia]]/[[myalgia]]
* Dry cough, wheezing
* [[Cough|Dry cough]], [[wheezing]]
* Abdominal discomfort
* [[Abdominal pain]]
* Diarrhea  
* [[Diarrhea]]
|-
|-
| rowspan="5" |Chronic schistosomiasis
| rowspan="5" |Chronic schistosomiasis
|Schistosomal nephropathy present with varying degrees of fatigue and asthenia
|'''Schistosomal nephropathy''' present with varying degrees of [[fatigue]] and [[asthenia]]
|-
|-
|Intestinal schistosomiasis may develop episodic intestinal bleeding and tenesmus.
|'''Intestinal schistosomiasis''' may develop episodic [[Hematochezia|intestinal bleeding]] and [[tenesmus]].
*Patients infected with S japonicumcan develop upper abdominal pain unrelated to meals, gastric bleeding, and pyloric obstruction due to eosinophilic inflammation and fibrosis.
*Patients infected with ''S japonicumcan'' develop upper [[abdominal pain]] unrelated to meals, [[gastric bleeding]], and [[pyloric obstruction]] due to eosinophilic inflammation and [[fibrosis]].
*Patients infected with S mansonican develop inflammation with symptoms that resemble those of Crohn disease or ulcerative colitis.
*Patients infected with ''S mansonican'' develop inflammation with symptoms that resemble those of [[Crohn disease]] or [[ulcerative colitis]].
Hepatosplenic schistosomiasis may present with cataclysmic esophageal variceal hemorrhage.
'''Hepatosplenic schistosomiasis''' may present with cataclysmic esophageal variceal hemorrhage.
|-
|-
|Urinary schistosomiasis presents with  hematuria and dysuria
|
Urogenital schistosomiasis present with genital pain, pelvic pain, coital bleeding, and dyspareunia.
* '''Urinary schistosomiasis''' presents with  [[hematuria]] and [[dysuria]]
 
* '''Urogenital schistosomiasis''' present with genital pain, [[pelvic pain]], coital bleeding, and [[dyspareunia]].
|-
|-
|Neuro-schistosomiasis may present with seizures, transverse myelitis or symptoms similar to those of cauda equina syndrome (eg, low back pain, lower extremity weakness, bowel and bladder symptoms) due to inflammation at the nerve roots
|'''Neuro-schistosomiasis''' may present with [[seizures]], [[transverse myelitis]] or symptoms similar to those of [[cauda equina syndrome]] (eg, [[low back pain]], lower extremity weakness, bowel and bladder symptoms) due to inflammation at the nerve roots


Granulomatous inflammation in the CNS can result in conus medullaris syndrome or schistosomal cerebritis (most commonly caused by S. japonicum)
Granulomatous inflammation in the CNS can result in [[Conus medullaris|conus medullaris syndrome]] or schistosomal cerebritis (most commonly caused by ''[[Schistosoma japonicum|S. japonicum]]'')
|-
|-
|Pulmonary schistosomiasis experience dyspnea on exertion, fatigue, and hemoptysis.
|'''Pulmonary schistosomiasis''' experience [[dyspnea]] on exertion, [[fatigue]], and [[hemoptysis]].
|-
|-
|Schistosome dermatitis  
|Schistosome [[dermatitis]]
( swimmer's itch)
( [[swimmer's itch]])
|Uncommon manifestation.
|Uncommon manifestation.
A pruritic papular rash occurs within 24 hours after the penetration of cercariae and reaches maximal intensity in 2 to 3 days.
A pruritic papular rash occurs within 24 hours after the penetration of cercariae and reaches maximal intensity in 2 to 3 days.
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[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Neglected diseases]]
[[Category:Neglected diseases]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]

Latest revision as of 18:43, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

The majority of patients with schistosomiasis in early phase are asymptomatic, unless katayama fever, an acute immune complex disease, occurs. Late schistosomiasis is symptomatic and includes hepatosplenic schistosomiasis (presinusoidal portal hypertension), urinary and urogenital schistosomiasis (urinary obstruction, genital symptoms), schistosomal glomerulopathy (chronic immune complex deposition in the kidney), and ectopic disease in areas such as the lungs and central nervous system (CNS).

History

The significant information that needs to focused in the history of the patient includes

  • Any history of travel to the endemic areas
  • Any ill contact with similar complaints

Symptoms

Clinical manifestations of schistosomiasis can be divided into:

  • Schistosome dermatitis
  • Acute schistosomiasis (katayama fever)
  • Chronic schistosomiasis[1]

Acute schistosomiasis(Katayama fever)

Chronic schistosomiasis

Intestinal schistosomiasis

Schistosomal nephropathy

Urogenital schistosomiasis

Pulmonary schistosomiasis

Neuroschistosomiasis

  • In hospitalized adult patients with S. japonicum infection, cerebral schistosomiasis occurs in 1.7 to 4.3%.
  • It may occur as early as 6 weeks after infection, and the most common sign is focal jacksonian epilepsy.
  • Signs and symptoms of generalized encephalitis may occasionally be found.
  • In S. mansoni infection, neurologic involvement is rare and mainly characterized by transverse myelitis, which occurs mainly in patients without liver fibrosis and hepatosplenomegaly.

Schistosome dermatitis

  • Schistosome dermatitis, or swimmer's itch, is an uncommon manifestation seen mainly when avian cercariae penetrate the skin and are destroyed.[7][8]
  • Schistosome dermatitis is a sensitization phenomenon occurring in previously exposed persons.
  • The cercariae evoke an acute inflammatory response with edema, early infiltration of neutrophils and lymphocytes, and later invasion of eosinophils.
  • A pruritic papular rash occurs within 24 hours after the penetration of cercariae and reaches maximal intensity in 2 to 3 days.

The table below summarizes the symptoms of schistosomiasis

Symtoms
Acute schistosomiasis

(Katayama fever)

Chronic schistosomiasis Schistosomal nephropathy present with varying degrees of fatigue and asthenia
Intestinal schistosomiasis may develop episodic intestinal bleeding and tenesmus.

Hepatosplenic schistosomiasis may present with cataclysmic esophageal variceal hemorrhage.

Neuro-schistosomiasis may present with seizures, transverse myelitis or symptoms similar to those of cauda equina syndrome (eg, low back pain, lower extremity weakness, bowel and bladder symptoms) due to inflammation at the nerve roots

Granulomatous inflammation in the CNS can result in conus medullaris syndrome or schistosomal cerebritis (most commonly caused by S. japonicum)

Pulmonary schistosomiasis experience dyspnea on exertion, fatigue, and hemoptysis.
Schistosome dermatitis

( swimmer's itch)

Uncommon manifestation.

A pruritic papular rash occurs within 24 hours after the penetration of cercariae and reaches maximal intensity in 2 to 3 days.

References

  1. ↑ Gray DJ, Ross AG, Li YS, McManus DP (2011). "Diagnosis and management of schistosomiasis". BMJ. 342: d2651. PMC 3230106. PMID 21586478.
  2. ↑ Jensen T, Rønne-Rasmussen JO, Bygbjerg IC (1995). "[Acute schistosomiasis (Katayama fever)]". Ugeskr. Laeg. (in Danish). 157 (35): 4825–7. PMID 7676521.
  3. ↑ Doherty JF, Moody AH, Wright SG (1996). "Katayama fever: an acute manifestation of schistosomiasis". BMJ. 313 (7064): 1071–2. PMC 2352353. PMID 8898604.
  4. ↑ Baharoon S, Al-Jahdali H, Bamefleh H, Elkeir A, Yamani N (2011). "Acute pulmonary schistosomiasis". J Glob Infect Dis. 3 (3): 293–5. doi:10.4103/0974-777X.83539. PMC 3162819. PMID 21887064.
  5. ↑ King CH, Dangerfield-Cha M (2008). "The unacknowledged impact of chronic schistosomiasis". Chronic Illn. 4 (1): 65–79. doi:10.1177/1742395307084407. PMID 18322031.
  6. ↑ Mourra N, Lesurtel M, Paye F, Flejou JF (2006). "Chronic schistosomiasis: an incidental finding in sigmoid volvulus". J. Clin. Pathol. 59 (1): 111. PMC 1860253. PMID 16394292.
  7. ↑ MILLER MJ, MUNROE E (1951). "Schistosome dermatitis in Quebec". Can Med Assoc J. 65 (6): 571–5. PMC 1822311. PMID 14886855.
  8. ↑ González E (1989). "Schistosomiasis, cercarial dermatitis, and marine dermatitis". Dermatol Clin. 7 (2): 291–300. PMID 2670374.
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