schistosomiasis (bilharziasis, Katayama fever)
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Introduction
Acute schistosomiasis is Katayama fever.
Etiology
- Schistosoma haematobium (blood fluke)
- Schistosoma japonicum (intestinal venules)
- Schistosoma mansoni (intestinal venules)
- Schistosoma mekongi
Epidemiology
- infection is acquired through freshwater contact, from which larvae infect humans via skin penetration.
- snails are intermediate hosts & release larvae into water
- the larvae can penetrate human skin
- adult worms may live in human body for years
- sub-Saharan Africa
Pathology
- Schistosoma haematobium infests plexus of bladder & pelvis
- Schistosoma mansoni resides in mesenteric venules
- eggs migrate to liver, lung, genitourinary tract, intestines & CNS
- immunologic response to the antigens present during the maturation process of the schistosomal worm
- trapped eggs can lead to granulomatous inflammation of periportal spaces progressing to fibrosis, occlusion of the portal veins with resulting esophageal varices
Clinical manifestations
- most cases asymptomatic
- acute manifestations 2-10 weeks after exposure (Katayama fever)
- painful urination (may or may not be present)
- perineal fibrous nodules
- hepatomegaly, no ascites[6]
- melena[6]
- esophageal varices[6]
Laboratory
- complete blood count
- urinalysis:
- hematuria
- ova occasionally found in urine
- 3 separate sample on 3 separate days for Schistosoma haematobium
- stool for ova & parasites: ova in stool
- liver function tests normal
- no stigmata of chronic liver disease
- see ARUP consult[3]
Diagnostic procedures
- Cystoscopy:
- papillomas at trigone
- reduced bladder capacity
- urinary calculi in
- rectovesical fistulas
- colonoscopy with colonic biopsy
Radiology
- chest X-ray
- ill-defined nodular infiltrates (case report)[4]
Differential diagnosis
- Ascaris, trichinellosis, filariasis, Hookworm
- none are transmitted in fresh water
Management
- praziquantel
- 40 mg/kg in 2 doses (same day)
- S. mansoni
- S. haematobium
- 60 mg/kg in 3 doses (same day)
- S. japonicum
- S. mekongi
- single oral dose of praziquantel, preferably given after acute stage (case report)[4]
- 40 mg/kg in 2 doses (same day)
- oxamniquine (alternative agent)
- 15 mg/kg once
- 30 mg/kg once in East Africa
- 30 mg/kg once daily for 2 days in Egypt & South Africa
- metrifonate* 7.5-10 mg/kg given every other week x 3
* Available from Centers for Disease Control, Parasitic disease division
More general terms
Additional terms
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 932
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 927
- ↑ 3.0 3.1 ARUP Consult: Schistosoma Species - Schistosomiasis The Physician's Guide to Laboratory Test Selection & Interpretation https://arupconsult.com/content/schistosoma-species
- ↑ 4.0 4.1 4.2 4.3 Puylaert CAJ, van Thiel PP IMAGES IN CLINICAL MEDICINE. Katayama Fever N Engl J Med 2016; 374:469. February 4, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26840136 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1504536
- ↑ Gleeson SE, Zhang X, Azar MM Recurrent Hematochezia in a Returning Traveler. JAMA. Published online March 5, 2021. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33666646 https://jamanetwork.com/journals/jama/fullarticle/2777393
- ↑ 6.0 6.1 6.2 6.3 NEJM Knowledge+ Gastroenterology