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2
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Contents
Introduction
...........................................................................................................................
.....3

Geographical Distribution of
occurrence.....................................................................................6

Pathogenesis......................................................................................................
..........................8

The disease of
man....................................................................................................................
..9

The disease of
animal................................................................................................................
..10

Source of infection & Mode of Transmission

............................................................................11

Role of animal in the epidemiology of the

disease..................................................................... 12

Diagnosis............................................................................................................
.........................13

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Schistosomiasis
Synonym:-

Bilharziasis, katayama syndromes (a cute schistosomiasis)

Aetiology:
The primary gents of human schistosomiasis are the three classic species of
blood trematodes:

Schistosoma mansoni.
Schistosoma japonicum.
Schistosoma haematobium.
Occasionally, man is invaded by species of Schistosoma that parasitize
other animals. Because of their close relationship to the classic
species, non human schistosomes have been grouped with them into
complexes.
S. Rodhaini, a parasite of dogs, cats and rodents belongs to the
mansoni complex.
S. Margrebowiei, a parasite of antelopes, bovine, equines &sheep
belongs to the japonicum complex. This also includes S.Mekongi
species.
Species that infects man and dogs in Kampuchea(Voge
etal,1974)assigned to the Haematobium complex are;-
A-S.bovis (bovines, camels, goats, sheep &pigs)
B-S.mattheei (bovines, goats, sheep rodents, &other animals)
C-S.intercalatum (domestic &wild ruminants of central Africa)
*-Mixed infections between human &animal species occur with some
frequency in parts of the old world.
The different strains of Schistosoma vary in their infectivity for snails
and snail species, as well as populations within the species, and vary in
their susceptibility to the parasite,

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 Schistosomes live in the vascular system. S.Mansoni is found primarily
in the mesenteric veins that drain the large intestine and especially in
the sigmoid branches and S.Hematobium locates in the plexuses of the
vena cava system that drains the bladder, pelvis and uterus.
The eggs are shed mainly with the faecal matter in infections caused
by S.Mansoni and with the urine in the parasitosis caused by
S.Hematobium.
The eggs hatch when they reach fresh water and the released
miracidia larvae ref {E.J.L.Soulsby}.
Miracidia infect aquatic snails which are the intermediated host,
S.Mattheei infects bulinus (Physopsis) africanus, B. (p.)Globosus and B.
(P.) nastusus.
Schistosomes bovis also infects these snails and in additions, bulinus
truncates has been implicated as an intermediate host ref {Malek,
1961}. While intermediate host of S.Mansoni are planorbids of genus
biomphalaria, especially biomphalaria glabrata. Schistosoma
hematobium develops in bulinus truncatus, B.forskali and B.
Obtusispira, and S.Spindale develops in snails of the genera planorbis,
indoplanorbis and lymnaea
The Miracidia which invade suitable water snails &develop through
Primary & Secondary sporocysts to become cercaria, when fully Mature
The cercaria leave the snail & swim freely in the water, Ultimately
gives rise to cercaria with a frocked tail.

Approximately 1 month elapses from Penetration of the Miracidium of

Schistosoma Mansoni into a suitable snail to the emergence of
cercaria.

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 A single Miracidium can give rise to more than 100.000 cercar

Figure 1

Emergence of cercaria from the snail is periodic of those of S.mansoni

tend to emerge in daylight 09.00 to 14.00 hours. Although emergence
is inhibited or partially inhabited to temperature of below 21C◦ peak
shedding of cercaria of S.matteei occurs at about 17c◦ and in the eastern
Transvaal this occurs between 21:00 – 14:00 hours in mid-water and 06:00 –
08:00 hours in summer.
Infection of the definitive host is though active skin penetration of the
cercaria although cercaria may penetrate the wall of the rumen when
swallowed with water.
Skin penetration is assisted by the secretions of the cephalic glands
which digest the tissues. The cercaria transform into Schistosomula

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 which are transported to the lungs via the circulation within seven
days.
They are then carried to the river, presumably via the blood stream,
and from eight days on words schistosomula are found in the portal
vessels of the liver.
Pairing of the worms takes place in the portal veins before they leave
the liver to reach Maturity in the Mesenteric veins.
4- Schisms
Cattle and Horses may become infected when standing in the shallow
waters of dams, rivers, etc. During the heat of day, they and other
animals are also infected orally when water tanks of other source of
drinking water become infected with snails and contaminated with
fecal material.
Geographical Distribution of occurrence:-
Shistosomiasis occur in 79 developing countries that together have a
population of the three billion inhabitants, approximately 600 million of
when are at risk of contracting the disease (Mahmoud, 1984).
S. mansoni has the widest geographical distribution; it is
found in 52 countries located in Arica, the eastern Mediterranean, the
Caribbean, and South American.
Schistosoma bovis: (sonsino, 1876) occurs in portal and
mesenteric veins of cattle, sheep and goats in central, east and West
Africa, the Mediterranean area and in the middle east.ref
{E.J.L.soursby}.
Schistosoma mansoni: sambon, 1907 occurs in the
mesenteric veins of man in Africa, South America and the Middle East
and humans are the most important definitive host. However, a variety
of animals have been found to be naturally infected with Schistosoma
mansoni these include gerbils and Nile rats in Egypt, rodents in
southern Africa and Zaire, various species of rodents and wild
mammals and cattle in Brazil and baboons, rodents and dogs in east
Africa .up to 50% of baboons are infected in some areas in east Africa.
The Nile Delta is a hyper endemic area of Schistosoma mansoni
infection. Autochthonous cases also occur in Yemen and Saudi Arabia.
Schistosoma haematobium: the agent of vesicle
schistosomiasis is endemic in 53 countries in Africa, as well as in the
Middle East and a locus of infection has been reported in India. Man is
the only significant maintenance host of this species although the
infection has been found in animal, e.g. baboons and monkeys in east
Africa, rodents in Kenya and eastern Africa ,pigs in Nigeria and
chimpanzees in west Africa . There is no unequivocal evidence that
animals play a role in the human disease.
According to various estimates, 100 to 300 million people in the world
are infected by one or another species of Schistosoma.

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 In Africa, the construction of dams has also contributed greatly to the
infections spread. In different areas of that continent, rates of infection
by S. Mansoni and S. Haematobium vary from 10 to 80%. It is
estimated there are close to a million infected persons in Yemen.

Map 1.1 schistosomiasis .Geographic distribution of Schistosoma

haematobium appear in Sudan and Other countries of Africa

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Map 1.2 schistosomiasis .Geographic distribution of Schistosoma mansoni appear in Sudan .

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Pathogenesis:-
Injury to the definitive host can result from the presence of adults
in the veins, ova in veins or tissues or cercaria as they penetrate the skin.

The adult blood flukes living within the veins may produce some phlebitis
with Intiman proliferation and occasionally venous thrombosis. Vascular lesion
are most likely to be severe when the adult worms die or are trapped in UN
usual sites.

The adult schistosomes also consume erythrocytes and discharge blood

pigment, which is engulfed by macrophages and may be found in
reticuloendothelial tissues in the liver and spleen this pigment appears in the
cytoplasm of macrophages as black granules, the ova of the blood flukes are
the most important factors in the production of lesion.

The ova deposited in the venules reach venous capillaries adhere to and
become embedded within the endothelium rupture the basement membrane
by means of enzymes secreted through the pores of the egg shell by the
miracidium within, and escape into the tissues to make their way to the
lumen of the intestine or urinary bladder.

This migration lead to small hemorrhagic ulcers, which in extensive

infestations to antigens released by the eggs. This hypersensitivity reaction
lead to the formation of granulomas composed of neutrophils, lymphocytes,
macrophages and multinucleated giant cells.

These granulomas or pseudotubercals are a characteristic feature of

schistosomiasis and may be wide spread, leading to extensive tissue
damage. The tissue reaction and microscopic appearance of the egg shell are
characteristic. The ziehl- nelson stain is useful in differentiating some
Schistosoma eggs.

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Cutaneous lesions develop in humans and animals as Aversa of penetration
of the skin by cercaria of Schistosomes the intensity of the tissue reaction
depends to some extent upon the sensitivity and resistance of the host to the
parasite.

As the cercaria reach the dermis, a leukocytic reaction of varying

intensity results, including neutrophils, lymphocyte & eosinophile this is
accompanied by urticaria, itching & the formation of ting nodules that elevate
the epidermis. In sensitised animals or humans, a sever tissue reaction
occurs, and death of the parasite in dermis may set up a prolonged local
tissue reaction.

Cercaria have the ability to penetrate the epidemics of hosts in which

complete development of the fluke does not occur; in this case the cercaria
die in the dermis, this is the basis of cercaria dermatitis (swimmer’s itch,
collector’s itch, swamp itch).

The Disease in Man:-

The majority of infected persons harbour few parasite; it is estimated that
less than 10% of those infected have along number of parasites and suffer a
severe chronic disease of the liver or the urinary tract.

School- age children and occupational groups such as fishermen, who enter
the water frequently and stay a long time, have more intense infections due
to the accumulation of parasites .ref{ Warren,1982}.

The symptomatology of schistosomiasis as it develops is generally divided

into four phases.

The first phase:-

Corresponds to penetration by the cercaria and is sometimes manifested by

dermatitis.

The second phase:-

Corresponds to invasion by the schistosomula; this stage may pass a

symptomatically or may be evidenced by coughing and a sthmati form crises
caused by the passage of the parasite through the pulmonary capillaries.

The third phase:-

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The acute or toxaemic stage corresponds to the maturation of the parasite
and the beginning of ovipositor; it is characterized by.

Fever.
Prostration.
Anorexia.
Diarrhoea.
Eosinophillia.
At times discrete hepatosplenomegally.

The fourth phase( chronic phase):-

Corresponds to proliferation of the parasite and tissular inflammation caused

by egg deposition in different organ, S.Mansoni in man primarily gives rise
to lesion in the intestinal wall; in time the spread to the liver and produce
interlobular fibrosis and portal hypertension, ascites and splenomegaly.

In advanced stage there may be pulmonary lesions and respiration

symptoms. In the chronic phase, the intestinal, hepato intestinal, hepato
splenic and pulmonary clinical form can be distinguished.

S.hematobium in man the lesion and symptoms mainly involve the

urogenital tract and to a lesser extent the intestine.

Papillomatous fold, pseudo abscesses and military pseudo tubercles form in

the wall of the bladder; obstruction of the urethra and the ureters is common.

The main symptoms of S.Haematobium consist of hematuris , painful and

frequent urination.

The species of non human schistosomes ,such as S.Bovis, S.Rodhaini and

S.Margrebowiei, produce an abortive infection in man .

N.B; { the parasite does not reach maturity}.

Disease in animals:-

The migration of large numbers of schistosomula through the lungs may

cause a temporaray cough but this is rare. Acute heavy infections are
manifested by profuse diarrhea or dysentery, dehydration and anorexia,
these signs develop at the time of patency seven to nine weeks after
infections. Anaemia and hypoalbuminaemia are present, sometimes with
oedema.

There is marked decrease in production or loss of weight. Chronically infected

animals are emaciated, microscopically eosinophilia, anaemia,
hypoalbuminaemia and perhaps hypergammaaglobulinaemia. Neurological
signs may be seen.

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Experimental infection of six calves with 30,000 cercaria of S.Mansoni lesions
similar to those occurring in man and other vertebrates were observed in
autopsy.

The eggs were viable and produced miracidia that were infective for
Biomphalaria Globrata .the rate of natural S.Mansoni infection in bovines in
an endemic area of minas gerais .Brazil, was low (less than 3%) ref{Coelho et
al., 1982}.

At presence time In White Nile State, Sudan , there were approximately 813
samples of feaces from different species of animal during 2008,which render
the rate of infection jumping to 26% this apparently in the pie chart diagram
with comparing to common disease in the same year .

Percentage of diseases during 2008

Source of infection & Mode of Transmission :-

Schistosomiasis is very important in Pupluc Heahth because of the

debilitating effect it has on people throughout large areas of the world .

The opening of new agricultural areas by irrigation projects creates an

environment favorable for snail reproduction . And the migration of
parasitized individuals provides a source of infection for the Mollusks .

An example of the influence of environmental changes on the disease is the

construction of the aswan dam in Egypt . This dam , which has benefited the
national economy , has also wrought profound ecologic change in the region
and has favored the increase of population of Mollusks that serve as the
intermediate hosts of S. mansoni , but not of S. haematobium .

Before construction of the dam , s. mansoni schistosoiasis was common in

the Nile Delta , but not very frequent in the region from Cairo to Khartoum
(Sudan).

These changes faroverd both Penetration of mirasidia into snails and human
contact with the cercaria that emerge from them .Furthermore , an increase
occurred in human activity connected with the Nile , such as fishing and
washing of clothes and utensils.The growing frequency of large dam
construction in developing countries , some times without the ecologic and
epidemiologic studies needed to established preventive measures , bring s
with it the spread and intensification of schistosmaisis .

Snails of the genera Biomphalaria & Bulinus , intermediate host for S.mansoni
& S.haemtobium , respectively , one aquatic Mollusks that flourish in
irrigation canals , lagoons , river back waters & small Nalural poolsof water

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Hybridization between S.haematobium and ( animal ) schistosomes has
important repercussions on control . Beside introducing the possibility of an
animal reservoir , the hybridization Provoks worry because the hybrids of
S.haematobium & S. mattheei show graeter infectivity for snail , mature more
quickly ,and produce more eggs ( Wright and Ross,1980).

Studies carried out in endemic areas have confirmed that the infectivity of
most bodies of water is low ; less than 5% of snails are infected , and cercaria
are dispersed throughout a large volume of water .Often with concentration
as low as one (1)per liter of water . Like wise ,cercariado not survive more
than afew hours if they do not find a suitable definitive host .

These facts indicates that when contact with contaminated water is brief,the
resulting human infection will usually be mild and asymptomatic
(Warren,1982).

The infection depends on the population or individuals length of exposure to

water contaminated with cercaria .

The most regions schistosomiasis is primarily a disease of (1) farm lsborers

who work in irrigated fields (rice ,sugarcane) (2) and fishermen who work in
fish culture ponds & River .(3) Another exposed group is women who wash
clothes or utensils along the banks of pools or streams .(4) the infction can
also be contracted while bathing , swimming , and playing in water .

Avery interesting aspect of infection by schistosomes is cross or heterologous

immunity , for which the unsuitable name (Zooprophylaxis )has been
proposed.

In many areas of Africa , Manis exposed to cercaria of animal schistosomes

which are often more abundant than those of S.heamatobium and S.mansoni
and originate in the same Mollusks.

Experimental evidence show that the infections caused by heterologous

species confer partial immunity , consisting of attenuation of the sererity of
the natural disease and resistance against reinfection.

Such protection can occur both in man infected with animal strains and in
animals infected with human species (S.Mansoni or S.Hematobuim).

Role of animals in the epidemiology of the disease:-

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Man is the main reservoir of S.Hematobium
and S. Mansoni, this disease can be considered
as common to man and animals; the Diagram of diseases in WNS in
Sudan,2008 1
parasitecan move freely between species
through the intermediate hosts, except in a
few situation of physiologic adaptation
(geographic strain).

The role of animals in schistosomiasis caused

by S. Mansoni is more difficult to define the
animals may contribute to the spread and
prevalence of the parasitosis.

Observations made in Africa indicate that

baboons (papio spp) can maintain the
parasitosis in their population and can give
rise to human infections.

N.B; / man is an accidental host in infections

caused by animal schistosomes, but evidence
indicates that some species (S. Intercalatum
and S. Mattheei) have atendency to adapt to
humans.

Epidemiology studies of S.bovis of infection

of cattle in the Sudan showed a significant fall
in age-specific prevalence and intensity,
based on faecal egg counts (Majid et al.
1980) and this was demonstrated to be due
to naturally acquired resistance of S.Bovis
(Bushara et al, 1980).

Diagnosis:-

Specific diagnosis is based on demonstrating the presence of egg in fecal

material or in both urine and feces (for S.Hematobium ). Non operculate eggs
are characteristic of each species of human schistosome. Egg of S.Mansoni
are yellowish brown, measure 110 to 180 microns in length by 40 to 70
microns in width, and have a characteristic lateral spine. The eggs of S.
Haematobium are approximately the same size and have a very pronounced
terminal spine.in advanced chronic cases, eggs may be few and difficult to
find; thus , if the faecal examination is negative, Kato’s thick film method,
concentration by formalin-ether or acid-ether, or examination of rectal
scrapings (S.Mansoni) should be tried. The presence of the parasite’s eggs is
undeniable proof of infection, and examination of faeces or urine should
always be part of the diagnosis procedure. Proctoscopy may reveal small
ulcerations and nodules.

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The various immunobiologic tests ; 1) complement fixation, 2)precipitation,3)
circumoval radial immune precipitation, 4) flocculation, 5) hemagglutination,
6) immunofluorescence, 7) thin layer immunoassay all of these are useful,
but they lack specificity and some lack sensitivity.

The recently introduced ELISA test has the advantage of allowing

deterimination of hte different types of antibodies (IgM, IgE, IgG) produced
during the course of the infection, as well as the proportion of antibodies
against different parasitic antigens (Egg, Cercaria and adult) in the acute and
chronic disease ( Lunde and Ottosen, 1980). Although may serologic methods
are currently available, their limited specificity has restricted their wider use
in diagnosis and epidemiologic studies (world health organization, 1980).

Treatment:-
The recent development of praziquantel seems to provide the drug of choice
for the treatment of schistosomiasis in man.

Generally the therapy of animal schistosomiasis has followed that for the
treatmentof human infections, but great care must be taken since very
variable results have been obtained. Many of the drugs kill the adult
schistosomes en masse and theses then become emboli in the portal veins;
portal occlusion and hepatic infarction may result and hepatic failure may
occur. The treatment of cattle infected with S.mattheei has been discussed by
Lawrence (1978a). Tartar emetic, antimosan and stibophen have been
effective in the treatment of S.mattheei in cattle but their use has been
associated with deaths among the treated animals. However, stibophen, the
sodium salt of antimosan, was very effective in cattle at a dose rate of 7.5
mg/kg given daily for six days. Lucanthone is also effective in the treatment
of S.mattheei in both cattle and sheep; 30mg/kg given on three alternate
days was effective in cattle and moderate efficacy. Was seen when sheep
received 30-50 mg/kg for three days.

Hycanthone has been used to treat sheep and an intramuscular injection of 3

mg/kg was moderately effective while 6mg/kg was highly effective. In
addition, niridazole was effective insheep at a dose rate of 100mg/kg for
three days. Very variable results have been obtained when trichlorophon has
been used to treat infected cattle and sheep. Thus, trichlorophon was
effective against S.bovis in cattle when 50-70mg/kg was given orally on four
to six occasions at three-days intervals. However, 75mg/kg was highly toxic
in some treated cattle infected with S. Mattheei. The lack of preparatory
starvation of the animls in the latter experiment may have affected the
toxicity.

Control:-
Control of schistosomiasis is based on control of the snail intermediate host
and treatment of infected persons and animals.

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Biological control has proved effective experimentally but has not yet been
shown to be effective in the field. The larval stages of Echinostoma spp. Are
predatory on schistosome larvae within the snail intermediate host. However,
the definitive host of echinostomes are limited in their distribution which
makes their use in nature impractical. Microsporidial protozoa such as
Nosema eurytremae can cause extensive damage to the intramolluscan
stages of schistosomes and other trematodes.

Snail population can be limited to low levels by the periodic application of

molluscicides such as Frescon and bayluscide to bodies of water. Also
contract between man and animals and snail-infested water should be
prevented. The fencing off of lakes and pools and the provision of piped
drinking water to troughs aid in preventing infection in animals. In addition,
water troughs should be mechanically cleaned periodically. The molluscan
intermediate hosts of schistosomes prefer slow-moving or stationary water,
so that an increase in the speed of water in irrigation channels will reduce the
snail populations.

The education of humans at risk, the provision of sanitary facilities and the
provision of piped water to houses, laundry units and swimming pools
reduces human contact with contaminated water.before night soil is allowd to
contaminated water it should be treated by fermentation for 25-45 days. The
heat created is sufficient to kill schistosome eggs. When contact with water
cannot be prevented, since farmers and other workers may have to enter
water as part of their livelihood, these workers should be provided with
protective clothing. Also, repellants such as dibutylphthalate and benzyl
benzoate applied to exposed skin may be effective in preventing penetration
by schistosome miracidia.

Reference:
1- E. J. L. Soulsby (1982) Trematoda Rudolphi .Helminths, Arthropods and
protozoa of Domesticated animals ., 72-80.
2- Pedro N. Acho and Boris Szyfres ,schistosomiasis, zoonosis and communicable
diseases common to man and animal,689-703pp. 1994.
3- Merk veterinary manual, ninth edition ,28-30pp.,1998.
4- Rabak veterinary research laboratory record .2008.

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