Schistosomiasis
Definition
More commonly known as bilharzia, this is a parasitic disease caused by Schistosoma flukes.
Epidemiology
Rare in the UK, mega common in Africa, Asia and South America, second only to malaria.
Pathophysiology
Basically, little Jimmy goes swimming in water somewhere in the affected regions. The parasites get on his skin, burrow in, and migrate round the body. After about 8 weeks, they start producing loads of eggs. Commonly, the Schistosoma parasites head for the liver and the bladder, although it can be anywhere.
Whilst not ridiculously harmful, the body doesn't like all this, and produces a lot of eosinophils, to try and take out the worms. The affected parts of the body get a lot of immunoresponse, leading to liver fibrosis, glomerulonephritis, bladder scarring (and cancer), and colonic polyps.
Clinical Features
- Often asymptomatic.
- Some people get a mild fever upon infection, with sweats and lymphadenopathy.
- Haematuria, and other urinary symptoms are common, as well as ejaculate problems.
- Vague abdominal symptoms such as bloody diarrhoea or abdominal pain.
Investigations
- Eosinophilia is common.
- Eggs seen in urine, ejaculate, stool or rectal biopsies.
- Schistosomal serology
Management
The bug is immediately and effectively killed in the body by Praziquantel. So just give them that.
The WHO has some awesome guidelines for treatment: "When a village reports more than 50 percent of children have blood in their urine, everyone in the village receives treatment". Not sure that NICE would be happy with that!
Prognosis
More chronic than killer. People do die from the long term effects, but it takes a long time.