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Schistosomiasis is known as bilharzia or bilharziosis in many countries, after German physician [[Theodor Bilharz]], who first described the cause of urinary schistosomiasis in 1851. The first doctor who described the entire disease cycle was [[Pirajá da Silva]] in 1908. It was a common cause of death for [[Ancient Egypt]]ians in the Greco-Roman Period.<ref>[http://www.ucalgary.ca/uofc/Others/HOM/Proceedings-2004.pdf#page=13 "Proceedings of the 13h Annual History of Medicine Days"], a medical historical paper from University of Calgary. March 2004.</ref>
Schistosomiasis is known as bilharzia or bilharziosis in many countries, after German physician [[Theodor Bilharz]], who first described the cause of urinary schistosomiasis in 1851. The first doctor who described the entire disease cycle was [[Pirajá da Silva]] in 1908. It was a common cause of death for [[Ancient Egypt]]ians in the Greco-Roman Period.<ref>[http://www.ucalgary.ca/uofc/Others/HOM/Proceedings-2004.pdf#page=13 "Proceedings of the 13h Annual History of Medicine Days"], a medical historical paper from University of Calgary. March 2004.</ref>
==Classification==
==Classification==
There are five species of flatworms that cause schistosomiasis. Each causes a different clinical presentation of the [[disease]]. Schistosomiasis may localize in different parts of the body, and its localization determines its particular clinical profile.
Schistosomiasis may be classified into intestinal and urogenital schistosomiasis based on the organ involvement.
 
==Pathophysiology==
==Pathophysiology==
Schistosomes have a typical trematode vertebrate-invertebrate lifecycle, with humans being the definitive host.
Schistosomes have a typical trematode vertebrate-invertebrate lifecycle, with humans being the definitive host.

Revision as of 03:47, 11 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Schistosomiasis is an infection acquired through contact with fresh water infested with the infectious larval form of Schistosoma flat worms (trematodes). Although schistosomiasis is a tropical disease, travelers, students, immigrants, veterans, and tourists who previously lived in or visited regions where schistosomiasis is endemic, present worldwide. Early disease is usually asymptomatic, unless katayama fever, an acute immune complex disease, occurs Late disease 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). Diagnostic methods include visualization of Schistosoma eggs in formed stool, urine, and crushed biopsy tissues; serologic assays; and urinary antigen testing. Scarring patterns characteristic of hepatosplenic and urogenital disease may be seen on ultrasonography. Praziquantel is first-line treatment.

Historical Perspective

Schistosomiasis is known as bilharzia or bilharziosis in many countries, after German physician Theodor Bilharz, who first described the cause of urinary schistosomiasis in 1851. The first doctor who described the entire disease cycle was Pirajá da Silva in 1908. It was a common cause of death for Ancient Egyptians in the Greco-Roman Period.[1]

Classification

Schistosomiasis may be classified into intestinal and urogenital schistosomiasis based on the organ involvement.

Pathophysiology

Schistosomes have a typical trematode vertebrate-invertebrate lifecycle, with humans being the definitive host.

Epidemiology and Demographics

The disease is found in tropical countries in Africa, Caribbean, eastern South America, east Asia and in the Middle East. Schistosoma mansoni is found in parts of South America and the Caribbean, Africa, and the Middle East; S. haematobium in Africa and the Middle East; and S. japonicum in the Far East. S. mekongi and S. intercalatum are found focally in Southeast Asia and central West Africa, respectively.

Natural History, Complications and Prognosis

Above all, schistosomiasis is a chronic disease. Pathology of S. mansoni and S. japonicum schistosomiasis includes: Katayama fever, hepatic perisinusoidal egg granulomas, Symmers’ pipe stem periportal fibrosis, portal hypertension, and occasional embolic egg granulomas in brain or spinal cord. Pathology of S. haematobium schistosomiasis includes: hematuria, scarring, calcification, squamous cell carcinoma, and occasional embolic egg granulomas in brain or spinal cord. Bladder cancer diagnosis and mortality are generally elevated in affected areas.

Diagnosis

History and Symptoms

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.

Laboratory Findings

Microscopic identification of eggs in stool or urine is the most practical method for diagnosis. The stool exam is the more common of the two. For the measurement of eggs in the feces of presenting patients the scientific unit used is epg or eggs per gram. Stool examination should be performed when infection with S. mansoni or S. japonicum is suspected, and urine examination should be performed if S. haematobium is suspected.

Medical Therapy

Schistosomiasis is readily treated using a single oral dose of the drug Praziquantel. While Praziquantel is safe and highly effective in curing an infected patient, it does not prevent re-infection by cercariae and is thus not an optimum treatment for people living in endemic areas. As with other major parasitic diseases, there is ongoing and extensive research into developing a vaccine that will prevent the parasite from completing its life cycle in humans.

References

  1. "Proceedings of the 13h Annual History of Medicine Days", a medical historical paper from University of Calgary. March 2004.