Treatment of schistosomiasis (HAS)

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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.

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