Treatment of schistosomiasis (HAS)

January 2017

Definition


  • schistosomiasis is a parasite infection by flatworms which live in the circulatory system. There are five species of worms that are responsible of this infection :
    • Schistosoma mansoni (urogenital schistosomiasis ) ;
    • Schistosoma mansoni (intestinal and sometimes hepato-splenic schistosomiasis ) ;
    • Schistosoma mansoni, Schistosoma japonicum and Schistosoma mekongi (intestinal schistosomiasis with hepathic complications) ;
    • Schistosoma mansoni, Schistosoma intercalatum (rectal and genital schistosomiasis ).
  • Few cases have been registered in France. They are mainly:
    • Expatriates,
    • Tourists,
    • Migrants.
    • Contamination happens when bathing in fresh water (presence of molluscs).

Diagnosing schistosomiasis

Questionnaire

  • In order to diagnose schistosomiasis , the doctor must ask questions to the patient :
    • Travel to endemic country,
    • Geographical origin,
    • Immersion in stagnant fresh water with pruritus following bathing,
    • Antecedents of schistosomiasis .

Clinical signs

  • General signs :
    • Fever,
    • Weight loss,
    • Anemia,
    • Asthenia,
    • Sweating,
    • Headaches,
    • Cough,
    • Dyspnea (difficulties to breath) asthma form,
    • Articulation pains,
    • Muscular pains.
  • Uro-genital schistosomiasis :
    • Urinary signs
      • Difficulties to urinate,
      • Pollakiuria (frequent emissions but with small quantities),
      • Sub-pubic pains during micturition,
      • Terminal haematuria,
      • Infections of the urinary system,
        • Cystitis,
        • Parenchymatic infections.
      • Genital signs
        • For man : hematospermia, funiculitis, chronic epididymitis;
        • For woman : dyspareunia, leukorrhoea , hemorrhages, vulvar pruritus.
      • Intestinal or rectal and genital schistosomiasis :
        • Diarrhea,
        • Colic pains,
        • Anus-rectal pains,
        • Hepatomegaly (Enlargement of the liver beyond its normal size),
        • Portal hypertension (digestive hemorrhages, splenomegaly , ascites),
        • Jaundice.

Examinations

  • Among other things and considering the infected area by the schistosomiasis :
    • Parasitological check-up,
      • Urine, faeces, anatomo-pathological sampling,
      • IF, Elisa, Western blot,
    • Haemogram,
    • Liver check-up,
    • Ultrasound scan,
      • Urogenital,
      • Abdominal,
    • Proctoscopy ,
    • Endoscopy,
    • Uroscopy,
    • Sterility check-up,
    • ECBU,
    • Urinary strips.

Complications of the infection

  • Cardiac and pulmonary :
    • HTAP,
    • Left ventricular deficiency.
  • Neurological :
    • Intra-cranial hypertension,
    • Convulsions attacks,
    • Severe myelitis,
    • Medullary compression.
  • Cutaneaous (schistosomiasis on the external genital organs, perineal and gluteal areas) .
  • Recurring salmonella.
  • Cancerological (epidermoid cystic carcinoma, colic adenocarcinoma).

Treatment

  • Treatment of the infection :
    • Anthelmintic: praziquantel.
  • Treatment of the complications :
    • Antibiotics,
    • surgery,
      • Ablation of kidney,
      • Elimination of the stones,
      • Operation,
      • For portal hypertension: drugs (diuretic , beta adrenergic blocking agent ...), endoscopy, surgery.

Sources


_final_web.pdf schistosomiasis compliquée, HAS, october 2007.

Photographic copyright: Talisalex | Dreamstime.com

Related


Manejo de la bilharziasis complicada (Esquistosomiasis)
Manejo de la bilharziasis complicada (Esquistosomiasis)
Latest update on April 11, 2010 at 09:31 PM by owliance.en_ctrl_002.
This document, titled "Treatment of schistosomiasis (HAS) ," is available under the Creative Commons license. Any copy, reuse, or modification of the content should be sufficiently credited to CCM Health (health.ccm.net).